All Client COVID-19 Form

Due to the 2019-2020 outbreak of the Coronavirus (COVID-19), Mirror Mirror Skin Lab is taking extra precautions with the care of every guest to include a health history review and enhanced sanitation/disinfection procedures in accordance with the Local, State and CDC guidelines.

Symptoms of COVID-19 include:

Fever
Fatigue
Dry Cough
Difficulty Breathing

I agree to the following: *

I understand the above symptoms and affirm that I, as well as all household members, do NOT currently have, nor have experienced the symptoms listed above WITHIN THE LAST 14 DAYS. I affirm that I, as well as all household members, have NOT been diagnosed with COVID-19 WITHIN THE PAST 14 DAYS. I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 WITHIN THE PAST 14 DAYS. I affirm that I, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 14 DAYS. I waive all liability of Mirror Mirror Skin Co LLC and my esthetician if I unavoidable contract COVID-19. I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of skin care services, that I have elevated the risk of contracting the virus by being in a public setting, such as this facility and accept that risk. I understand the COVID-19 virus has a long incubation period, during which carriers of the virus may not show any symptoms and still be highly contagious. It is impossible to fully determine who is positive and who is not, given the current limits of screening in the facility and I accept the risk.

Mirror Mirror Skin Lab and my esthetician are following these enhanced procedures to prevent the spread of COVID-19:

Additional time included between appointments to sanitize service areas and to minimize guest contact.
Increased distance between clients to adhere to safe social distancing guidelines.
No visitors during your service.
Each guest is required to wash or sanatize hands upon arrival.
Your service provider will thoroughly wash and sanitize hands as often as possible
Everyone in the space must be masked. Guests receiving services must wear a mask or face shield that covers the nose and mouth completely. Until required to remove mask for treatment.
All surfaces will be wiped thoroughly with hospital grade disinfectant before and after each client.

By signing below, I agree to each statement above and release from any and all liability for the unintentional exposure or harm due to COVID-19. Mirror Mirror Skin Lab and my esthetician agrees to abide by these standards and affirms the same.

Name *

First Name Last Name

Cell phone *

Area Code Phone Number

Cancellations and Deposits - We try our best to make sure we save a time slot especially for you to give you the full attention you deserve. In order to keep the time available just for you, a $25 NON-REFUNDABLE
deposit is required for all appointments. All deposits will be applied as a credit to the total cost of your service. Please note that all appointment cancellations or reschedules need to take place at least 12 hours in advance of
your scheduled appointment. Failure to provide 12-hour advanced notification will cause forfeiture of deposit.

Refund Policy - We aim to please all of our clients and will do our best to make sure your service is top notch. Therefore, we have a NO REFUNDS policy.

Late Policy - Please arrive 5 minutes before your appointment to settle in and fill out some short paperwork. We know things happen sometimes, so if you are running more than 15 minutes late, please let us know and we
will try to fit you in for a shorter appointment or reschedule you for another time.

I am voluntarily participating in treatment by Mirror Mirror Skin Co LLC and I agree to indemnify and hold harmless against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf.

By signing, client acknowledges the provided information is true to the best of their knowledge and also acknowledges the policies set forth my Mirror Mirror Skin Co.

Date *

Date

Signature *

Clear

I confirm all of the above information to be true and agree to all terms and guidelines as listed above, and my agreement is in alternate of my signature. *

I agree and sign.

COVID-19 Liability Release Waiver