COVID-19 Informed Consent
Mandala Salon is in my home, and my son has asthma. I also have several clients with health conditions putting them at a higher risk of complications should they contract COVID-19.  I am taking extra precautions to keep my son and other high-risk clients safe.  If you disagree with these policies, or feel they are too strict, I respect your decision to have salon services done elsewhere.

Please note that based on your answers, your appointment may be rescheduled or cancelled in the interest of  protecting myself and others.  

We both are required to wear a mask at all times while in the salon, have our temperature taken at the beginning of your visit, and sanitize or wash our hands as you enter the salon.
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I understand that COVID-19 has been declared a global pandemic with no known cure or vaccine at this time.  I further understand that COVID-19 is extremely contagious and while there is uncertainty among the experts on how the virus can spread, it is believed there is a higher risk of spread through close physical proximity to infected persons.  
While I recognize that Stephany is taking extra precautions to protect me from COVID-19, I understand that my hair services are not medically necessary and come with inherent risks associated with the inability to maintain a 6-foot distance from my service provider.    I acknowledge and assume the risk of becoming infected with COVID-19 and give my express permission for Stephany Wiestling to proceed with these elective services.
Should I become infected with COVID-19 at any point after my services today, I hold Stephany Wiestling, her family and extended family, and Mandala Salon, LLC harmless of any damages or losses I may incur from receiving these elective services.
I am not currently ill or experiencing symptoms of any communicable illness, including COVID-19, and certify that I have not come into contact with anyone, including myself, testing positive to COVID-19, or displaying cold or flu symptoms within the past 14 days.
I agree to let Stephany Wiestling (Mandala Salon) know if I become ill within 14 days or test positive for COVID-19 within 14 days after my appointment to allow for contact tracing.
I understand that if I cancel or reschedule my appointment due to COVID-19 illness, Stephany may use my phone number or email address for contact tracing but will keep my identity private.
Client Name *
I am 18 yrs of age or older *
Parent / Guardian Name if under 18
E-mail *
Phone number
In-Salon Only: My Temperature Today
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