COVID-19 Appointment Protocol

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BY FILLING OUT THIS FORM, YOU ARE ACKNOWLEDGING AND AGREEING TO FOLLOW THE POLICIES OUTLINED BELOW. YOU ACKNOWLEDGE THAT YOU ARE RECEIVING SERVICES AT YOUR OWN RISK AND DO NOT HOLD JACKIE WILT OR FUEL SALON AND SPA LIABLE IF YOU DEVELOP ANY SYMPTOMS OR TEST POSITIVE FOR FLU RELATED TO THE CORONA VIRUS

First and Last Name *

Date *

YYYY

Email *

Mailing Adress *

Wellness Check

Are you currently displaying any of the following symptoms *

Cough

Fever

Sneezing

Sore throat

Sudden difficulty breathing

I am symptom free

Required

Have you been exposed to anyone who has tested positive or exhibited symptoms related to the Corona Virus in the last 14 days? *

Yes

Maybe

Other:

Have you tested positive for Corona Virus in the last 14 days? *

Yes

Maybe

Other:

If yes, how many days have you been symptom free? (Clients that test positive/exhibited symptoms aligned with Covid-19 virus or live with someone who has must reschedule their appointment 14 days after the first sign of symptoms appeared.)

Are you an essential worker that has had regular exposure to individuals fighting virus symptoms? *

Yes I am an essential worker that has been exposed to others exhibiting virus symptoms

No I am not

I wish not to say

Other:

Please give as much notice as possible when canceling your appointment if virus symptoms do occur. Appointments rescheduled with less than 48hrs notice due to symptoms and illness related to COVID-19 will be excluded from my policy fees until August 1, 2020. All other appointments canceled with less than 48hrs notice will follow my cancelation policy accordingly. View my policy at https://www.jackiewilt.com/cancelation-policy *

I understand you 48hr policy guidelines related to COVID-19

I have questions or concerns related to this matter

Appointment Arrival and Departure

Maintaining a low risk environment is key to maintaining client comfort and safety. We must limit the number of people in the salon at one time below are the appointment procedures that must be followed to ensure we abide client occupancy guidelines

It is recommended (not required) that you arrive to your appointment freshly showered in a fresh set of clothes if possible *

I will come to my appointment so fresh and so clean clean with my hair dried as I intend to wear it. The better you style the easier it is for me to give a good cut.

I have questions or concerns about this matter

I will do my best to make this happen

Additional guest will not be permitted into the salon for any reason, children, friends, and family will have to stay out of the salon at all times during your appointment as strict guidelines have been set to the number of people allowed in our space at any given time *

I understand I will not bring ANY additional guest with me to my appointment even if they have an appointment right after mine

I have questions or concerns about this issue

Currently, our waiting area is closed so our booking system will provide you the opportunity to check-in from your car and I will respond once I am ready for you to come in. Please be aware I will be with clients so there may be a delay in my response. Late arrivals will be subject to my late appointment policy procedures stated on my website https://www.jackiewilt.com/cancelation-policy *

I understand I need to send a text once I am in the parking lot

I have questions or concerns about this matter

Required

Please keep in mind with all the new sanitation procedures, limiting of extra staff, and use of salon equipment appointment times may need some adjusting as we learn how to function under these circumstances. I ask for your flexibility as I adjust to our new appointment guidelines and sanitation standards. I will do my best to inform you if I am running behind for any reason.

I understand my appointment time may extend beyond the norm and that Jackie may run slightly behind adjusting to the new schedule

I am concerned about the time my appointment will take and need to reschedule. (contact Jackie directly 720.663.9272)

Clear selection

While text will be exchanged to coordinate entering the salon please be advised that Jackie will not now or in the future make appointments through text message as appointments making needs to happen in realtime to avoid confusion and communication delay. Making, changing, or canceling all appointments now or in the future should be done by calling me directly or via our online booking feature. For the month of May online scheduling will be closed until further notice. *

I understand I will not be able to make, change, or cancel appointments via text messaging

I have questions or concerns about the matter

I will text you once my previous client has left the salon and my station has been fully sanitized following DORA sanitation guidelines. Please provide the correct number you would like to receive appointment text. *

Before you are seated for your appointment a contactless temperature check will be administered prior to your service being performed. If your temperature is above 100.4 you will be asked to reschedule. You may reschedule once you have been fever free for 72 hours without the use of temperature altering medications. *

I understand I will have a temperature check done prior to services being rendered

I have questions or concerns about the matter

PAYMENT PROCEDURES: CASH OR CHECK WILL NOT BE ACCEPTED. Debit/Credit cards will be accepted, apple pay or contactless debit/or credit are preferred. (Please take a moment to set up apple pay prior to arriving to your appointment)

I will be using apple pay

I will be using contactless debit/credit

I will be using a regular debit/credit

I don't have any of the option above

Clear selection

Health and safety protocol

I will be equipped with a fresh cape, clips, towels, and freshly sanitized stations for your individual use. Upon your arrival
i will be dressed wearing a mask, fresh apron, and gloves to minimize exposure and contamination

For your safety and the safety of our other guest wearing a mask at all times during your service will be a requirement until further notice. Mask must be worn throughout the entirely of your appointment. Your mask should not impede on my ability to perform your service. Please acquire a mask that hooks behind the ear. *

I understand I must wear a mask that hooks behind the ears and will wear said mask at all times while inside of Fuel Salon and Spa

I do not intend to wear a mask during my service and understand by doing so I forfeit the ability to receive services from Jackie Wilt or any stylist at Fuel Salon and Spa

We have removed all drinks and snacks for the time being. The consumption of drinks or snacks are not permitted in the presence of your service provider. Staying hydrated is important so please consume drinks at times when your service provider steps away. *

I understand that drinks and snacks will not be provided at this time and all consuming drinks during my appointment should be done when my service provider is not present

I have questions or concerns about this matter

Please keep in mind color services provided during your appointment may cause staining to the mask you provide. (An alternative washable mask can be provided) *

I understand that staining may occur during my salon service and do not hold Jackie or Fuel salon and Spa financially liable for its replacement

I will utilize an alternative mask that Jackie provides

I do not plan to wear a mask

Other:

If you answered "I have questions" to any questions of the above mentioned appointment protocol guidelines please write your questions below

I understand the importance of disclosing any symptoms that may develop between now and my appointment time and will contact Jackie immediately should I or someone at home or close to me develops symptoms related to Corona Virus. I acknowledge the importance of protecting the health of my service provider and other salon guests. I confirm that all answers I have given above are true to the best of my knowledge, and agree to inform Jackie Wilt of any health-related symptoms that may expose her to the virus due to the close proximity required in order for service to be performed. Type your name below *

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