COVID-19 Pre Screening Form
Name
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First Name
Last Name
Date
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Day
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I knowingly and willingly consent to having service(s) done at Antrice Aesthetics during the COVID-19 pandemic.
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by checking this box I understand and accept this statement.
To prevent the spread of contagious viruses and to help protect each other, I understand that i will have to follow the spa's strict guidelines
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by checking this box I understand and accept this statement.
I understand that if I have any doubt or feel any symptoms that I am not to enter the spa, but should cancel and ask to reschedule after being retested or after 14 days from the original appointment date. I understand that I will not be penalized and my deposit will transfer over to my new appointment.
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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 and still be highly contagious. It is impossible to determine who has it, and who does not give the current limits in virus testing.
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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
NO
I confirm that I have or have not been in contact with anyone being infected, suspected, or diagnosed with COVID-19 in the last 14 days?
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YES
NO
In-salon Symptoms Policy
I agree not to come to Antrice Aesthetics with the following symptoms of COVID-19 listed below: Fever- Temperature Shortness of breath Loss of sense of taste or smell Dry cough Runny nose 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 when visiting Antrice Aesthetics
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Yes
Signature
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