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Agree to Following
PLEASE BE HONEST WHEN COMPLETING THIS FORM. FULL DISCLOSURE IS NECESSARY IN ORDER TO KEEP ALL CLIENTS AND EMPLOYEES SAFE.
PLEASE DO NOT PUT ANYONE AT RISK: -IF YOU'VE KNOWINGLY BEEN EXPOSED, PLEASE ISOLATE, MONITOR YOUR SYMPTOMS AND GET TESTED.
-IF YOU'VE BEEN TESTED AND YOU'RE WAITING FOR THE RESULTS, PLEASE ISOLATE YOURSELF AND STAY HOME.
I confirm that I am not presenting any of the following symptoms of COVID19 listed below:
- Cough (especially a dry cough)
- Difficulty breathing
- Loss of taste and smell
- Shortness of breath
- Repeated shaking with chills
- Muscle pain
- Sore throat
- Runny nose
I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.
I affirm that I, as well as all household members, have not been diagnosed with COVID19 within the last 30 days.
I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID19 within the last 30 days.
I affirm that I, as well as all household members, have not traveled outside of the country, or to any city outside of our own that is or has been considered a "hot spot" for COVID19 infections within the last 30 days.
I understand that my temperature will taken by my technician using a contactless thermometer. I will be refused service if my temperature is greater than or equal to 100.0 degrees Fahrenheit.
I understand that Nirvana Beauty Bar & My Salon Suites and my technician cannot be held liable for any exposure to the virus or any other contagions caused by misinformation or undisclosed information on this form and/or on all health histories provided by each and every client that receives service in this salon.
I understand that the COVID19 virus has a long incubation period during which carriers of the virus may not yet show symptoms and still be highly contagious. It is impossible to determine who has it and who does not due to asymptomatic carriers, long 14 day incubation periods, limited testing and other variables.
I understand that I must notify Nirvana Beauty Bar & My Salon Suites IMMEDIATELY if any of the information above has changed. This is crucial in order to keep everyone in the salon and myself safe.
410 Park Ave W.
Denver, CO 80205
Phone: (303) 558-5224
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