WILLIAMSBURG BEAUTY SPA

WILLIAMSBURG BEAUTY SPA

COVID-19 Information and Consent Form
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Have you had any fever in the last 24 hours of 100°F or above?
In the last 14 days have you had any respiratory or flu symptoms, sore throat or shortness of breath?
Have you been in contact with anyone in the last 20 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms?
Credit card required to book all appointments. Enter Card #, Exp Date & Zip Code Below & Service Requesting
Appointment
COVID-19 is a highly contagious virus that spreads from person to person. In addition to long-held and explicit sanitation measures that Williamsburg Beauty Spa has always adhered to, new preventative measures have been put in place to further reduce the spread of COVID-19. However, these best practices guided by the CDC and other authorities still offer no guarantee regarding your potential risk of being infected.
Consent for Treatment
I understand that, because esthetics involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner and business from any claims related thereto. I give my consent to receive treatment from this practitioner.
Client Signature
Please sign name below:
Please verify that you are human
Should be Empty:

WILLIAMSBURG BEAUTY SPA

Consent for Treatment

Client Signature