Pre Appointment Screening Questionnaire | Ciro's Hair Pavilion

We all know that these are uncertain times. The risks of COVID-19 are not well understood and there is controversy among the experts on how the virus can spread and difficultly in scientifically determining whether anyone has the virus at any moment in time. In consideration for providing hair services, by signing below you agree to accept all responsibility for the risk that you may contract COVID-19. While we are taking your safety and that of our staff very serious, by employing new safety and sanitation initiatives, we cannot guarantee that any of these measures will completely protect you from contracting COVID-19. I agree that if I take any steps to make a claim for damages against Ciro's Hair Pavilion, its agents, employees or any other released parties arising out of my receipt of hair services during my visit to Ciro’s Hair Pavilion's facilities, I shall be obligated to pay all attorneys’ fees and costs incurred as a result of such claim.

Pre Appointment Screening Form

Required prior to arriving for your appointment, please take the time to fill out the information below. This is required by State Law 24 hours prior to appointment and again upon arrival.

*Instructions: Please make sure to finish this form to the end, sign and submit. Thank you.

Any questions or issues please call 201-791-6414 and we can screen you by phone

RELEASE OF LIABILITY AND AGREEMENT NOT TO SUE, INDEMNIFICATION, HOLD HARMLESS, LIMITATION OF WARRANTY