We protect your privacy and do not sell or disclose your health information, nor your personal contact information. Email address, phone numbers, and address are kept private. 

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Studio Abasi Covid-19 intake and waiver form

 

Studio Abasi is using the utmost care to protect our clients, community, and our staff. To this extent, we will be following the guidlines for personal care services with regard to social distancing and sanitation and disinfection practices set forth by; the Center for Disease Control and Prevention, (CDC), Alameda County Department of Health, the City of Berkeley Public Health Department, and the California State Board of Barbering and Cosmetology.

 

 


Review Privacy Policy

Please arrive 5 minutes early and text or call us when you have parked your car. Please wait in your car until we call or text you to come into the building. 

 

We ask that our clients disclose their health history and continue to implement these sanitation and disinfection procedures.

Symptoms of COVID-19 include:

Fever, Fatique, Cough, Nasal congestion, Difficulty Breathing, and loss of taste and smell

 

I agree to the following: 

I Agree
 I, nor members of my household, have not experienced any of the symptoms listed above within the last 14 days.

I Agree
I, nor members of my household, have not travelled internationally in the last 30 days.

I Agree
 I, nor members of my household, have not traveled to a highly impacted area within the United States of America is the last 30 days.

I Agree
 I, nor members of my household, do not believe that we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus (COVID-19)

I Agree
 I, nor members of my household, have not been diagnosed with the Coronavirus (COVID-19) within the last 30 days.

 

Studio Abasi, cannot be held liable from any exposure to the Coronavirus (COVID-19) caused by misinformation on this form or the health history provided by each client. If I take any steps to make a claim for damages against Studio Abasi, its agents, employees or any other released parties, I shall be obligated to pay all attorney’s fees and costs incurred as a result of such claim.

Studio Abasi is following these enhanced procedures to prevent the spread of the Coronavirus (COVID-19) -

All servies are by appointnment only. 

No walk-ins for product pick-up. Please send us an e-mail for product requests. 

Weather permitting, all services will be booked for our private outdoor garden patio with heaters. 

All clients must wear a surgical mask when entering and leaving the premises. 

No gator masks allowed.

Anyone who refuses to wear a mask will be denied entry into the building. 

Only one customer will be allowed in the treatment room at a time unless the client is minor, has a disablitly and requires an attendant, or is elderly and requires an attendant.

Customers are not allowed to linger in the reception area.  

No children allowed in the building or patio unless they are receiving a treatment. 

Additional time will be scheduled in between client appointments to limit client contact.

Each client is required to wash/sanifitze their hands upon arrival and before departure. 

All equipment used during treatment will be cleaned, sterilized, and disinfected.

All surfaces will be thoroughly cleaned with hospital grade disinfectant before and after each client, according to the manufacturer’s directions.

The City of Berkeley's Department of health, requires  customers recieving indoor services to wear a mask. We have custom made masks that cover the clients nose and mouth only, leaving the rest of the face exposed for treatments. 

If you have allergies that cause the sniffles, dry or wet cough, or congested sinus, please reschedule. 

 

First client Name

First Name*

Middle Name

Last Name*

Phone*
First client Date of Birth*
First client Signature*
Second client Name

First Name*

Middle Name

Last Name*
Second client Date of Birth*
Third client Name

First Name*

Middle Name

Last Name*
Third client Date of Birth*
Fourth client Name

First Name*

Middle Name

Last Name*
Fourth client Date of Birth*
Fifth client Name

First Name*

Middle Name

Last Name*
Fifth client Date of Birth*
Sixth client Name

First Name*

Middle Name

Last Name*
Sixth client Date of Birth*
Seventh client Name

First Name*

Middle Name

Last Name*
Seventh client Date of Birth*
Eighth client Name

First Name*

Middle Name

Last Name*
Eighth client Date of Birth*
Ninth client Name

First Name*

Middle Name

Last Name*
Ninth client Date of Birth*
Tenth client Name

First Name*

Middle Name

Last Name*
Tenth client Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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