Beauty Salon Consent Form

Obtain a client's informed consent and confirm they are symptom-free before providing the salon service.

Use this template

Client Name

First Name

Last Name

Appointment Date & Time

By checking the boxes, you confirm that you agree with the following statements:

I have no symptoms I have had no risky contact I understand the risks of the service

Do you have any of these symptoms? - cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of taste/smell

Yes No

Within 14 days, have you been in contact with anyone that has COVID-19 symptoms or get infected?

Yes No

Are you living with anyone that is get infected or quarantined due to COVID-19?

Yes No

Consent Statement

Parent/Guardian Name (if applicable)

First Name

Last Name

Date

Client/Parent/Guardian Signature

Sign here

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