First and Last Name (required)

Phone Number (required)

Date of Service (required)

In-Salon Temperature Policy

1. I’m willing to take a temperature check during my visit to the salon before service can start.




2. I confirm am not experiencing any of the following symptom of COVID-19 listed below:

• Fever -Temperature: 99 degree or Higher
• Dry Cough
• Shortness of breath
• Chest Pain
• Headache
• Loss sense of taste or smell
• Runny nose
• Sore Throat
• Muscle Pains
• Diarrhea
• Nausea/Vomiting

Have you been in contact with a person with COVID-19, in quarantine, or have symptoms of COVID-19 within the past 14 days. (required)
YesNo

I knowingly and willingly consent to have a nails, pedicure, eyelash, eyebrow waxing facial treatment during the Covid-19 pandemic. (required)
By checking this box I understand and accept this statement.

I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of nail, pedicure, eyebrow, or eyelash services, that I have elevated the risk of contracting the virus by merely being in the salon. (required)
By checking this box I understand and accept this statement.

I understand, read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that this document is to provide the best possible guest experience when visiting NOBLE NAILS SPA. I will not hold the salon responsible if I were contract COVID-19 infection around and during the time of services.
Yes.

Signature (required)