Healthy Nails and Spa COVID-19 Pandemic Nails Treatment Consent Form

HEALTHY NAILS AND SPA COVID-19 Pandemic Nail Treatment Consent Form
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your appointment Date and Time*

MonthDayYear
DateHourMinutesAM/PM Option
How many people for this appointment ?*
I, * , knowingly and willingly consent to have nail treatment during the COVID-19 pandemic at Healthy Nails and Spa.
I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not given the current limits in virus testing, therefore I will not hold the salon responsible if I were to contract COVID-19 infection around and during the time of services Healthy Nails and Spa.*

I understand and accept this statement.
I understand and accept this statement.

Do you have any following symptoms?*

Rows	Yes	No
Fever
Shortness of Breath
Loss of sense of taste or smell
Dry cough
Runny nose
Sore throat

HEALTHY NAILS AND SPA COVID-19 Pandemic Nail Treatment Consent Form