COVID-19 Consent Form

Clients Name*

First NameLast Name

Email

example@example.com

I acknowledge that The Artistry LLC is putting every effort in place to prevent any contact with the Corona Virus COVID-19 disease. Therefore I will answer the following questions honestly and truthfully.*

Please initial

I have not had any symptoms including headaches, shortness of breath, coughing, or any other COVID- 19 symptoms. I agree to notify The Artistry if this changes leading up to my appointment*

Please initial

I have not come in contact with anyone who has contracted the Corona Virus COVID-19 or any variants of COVID-19 and agree to notify The Artistry immediately if this changes and reschedule my appointment accordingly*

Please initial

Should I feel unwell, even with the slightest allergies resulting in runny nose or coughing, I will contact The Artistry LLC to reschedule my appointment- Please remember although we are wearing face coverings, the nature of our business and closeness of how we work, it is strictly preferred that you reschedule even with the slightest signs for your safety and ours.*

Please initial

I acknowledge that I will have to wear a 3 filter layer face mask to my appointment even if I am fully vaccinated. Cloth masks are not permitted and will be replaced with a new mask provided by your technician *

Please initial

I acknowledged all statements of those noted herein and I would like to proceed with this service. I have been offered a copy of this consent form. *

Please initial

I further understand that I am opting for a service that is not urgent and not medically necessary and that the coronavirus (COVID-19) has been declared a worldwide pandemic by the World Health Organization. I further understand COVID-19 is extremely contagious. State and federal health agencies recommend social distancing.

I recognize that the staff at The Artistry LLC are closely monitoring this situation and have put in place guidelines and preventive measures targeted to reduce the spread of this virus. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 if I proceed with the elected service.

Accordingly I acknowledge and assume the risk of becoming infected with COVID-19, and any variation or mutation thereof, through this elective service and I gave my express permission for the staff at The Artistry LLC to proceed with the same. This consent applies to any follow up or additional services in the upcoming months.

I understand that even if I have been tested for COVID-19 and received a negative test result, the tests may not have detected the virus or I may have contracted COVID-19 after the test. I will not hold The Artistry LLC and/or the technician offering the service responsible for any liability related to COVID-19 and any variation or mutation thereof.

I acknowledge all statements of those noted herein and I would like to proceed with my scheduled appointment. I have been offered a copy of this consent form.

DIGITAL FORM SUMISSION IS ACCEPTANCE OF TERMS OF SERVICE

Client Signature*

Print Name*

Date*

Date

Informed Consent COVID-19 Pandemic