COVID-19 Vaccination Status

Covid Vaccination Status

Your Name *

Have you received a COVID-19 vaccine?

Yes, I am fully vaccinated and boosted.

Yes, I am vaccinated but not boosted.

I have received one dose but not the second.

I haven't yet, but I plan to.

I do not plan to receive a vaccine.

I do not wish to share this information.

OtherOther

Which vaccine did you receive?

Pfizer

Moderna

Johnson & Johnson

What was the date of your final vaccine dose?

What was the date of your booster?

When do you expect to receive your 2nd dose?

Do you give your consent for us to share your vaccination status with clients who ask?

Yes

OtherOther

Please upload an image of your vaccination card, if applicable.

Maximum file size: 52.43MB

Would you be comfortable working with an unmasked client who is fully vaccinated? Assume that community transmission is low (Austin threat level 3 or below.)

Yes

Only if they have received the most recent recommended booster.

OtherOther

As conditions allow, we will be re-activating certain services that we have put on hold during the pandemic. Please indicate which of these services you would be willing to provide during times where transmission is low and we are able to relax policies.

Couples (same room) treatments, if everyone is vaccinated

Couples (same room) treatments, with masks, if clients are not vaccinated.

Facials, if everyone is vaccinated.

Facials, if clients are not vaccinated.

OtherOther

We are taking a cautious approach with covid policies and will never remove restrictions before we feel they are safe based on CDC regulations as well as the available evidence. With this in mind, do you have any concerns or suggestions that we should consider when making policy changes?

Please add any additional comments, clarifications or relevant feedback.

If you are human, leave this field blank.

COVID-19 Vaccination Status

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