Lash Service Consent Form
Due to the 2019-2020 outbreak of the novel Coronavirus, COVID-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete the following and sign below.
Name
*
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
I knowingly and willingly consent to having lash and salon service(s) during the COVID-19 pandemic.
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by checking this box I understand and accept this statement.
I confirm that I am not presenting any of the following symptoms of COVID-19 listed below: Fever, Shortness of breath, loss of taste or smell, dry cough, runny nose, sore throat.
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by checking this box I understand and accept this statement.
I understand the above symptoms and affirm that I, as well as household members, do not currently have, nor have experienced the symptoms listed above within the 14 days.
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by checking this box I understand and accept this statement.
I affirm that I, as well as household members, have not been diagnosed with COVID-19 within the last 30 days.
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by checking this box I understand and accept this statement.
I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms & still be highly contagious.
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by checking this box I understand and accept this statement.
I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of these services that I have an elevated risk of contracting the virus simply by being in the establishment.
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by checking this box I understand and accept this statement.
I verify that I have not traveled outside the United States In the past 14 days to countries that have been affected by COVID-19
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YES
I confirm that I have not traveled domestically within the United States by commercial airline, bus or train within the past 14 days
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YES
To prevent the spread of the contagious virus and to help protect each other, I understand that I must follow the establishment’s guidelines: Reschedule appointment if you are feeling unwell. No additional guest is allowed. Wearing a mask is required upon arrival and during the entire procedure. Wash hands upon arrival. Limit conversation during the procedure
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by checking this box I understand and accept this statement.
In-salon Symptoms Policy
I agree not to come to the salon with the following symptoms of COVID-19 listed below: Fever, High Temperature, Shortness of breath, Loss of sense of taste or smell, Dry cough, Runny nose, and Sore throat.
I understand, read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that this document is to provide the best possible guest experience. I, knowingly and willingly consent to have eyelash extension service during the pandemic and will not hold, Elegant Lashes by Katie, or anyone working for this establishment, liable for the possibility of contacting COVID-19.
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Yes
Date
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Month
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Day
Year
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Signature
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