Acrylics By Jael Consent Form - COVID 19 & Appointment

Acrylics By Jael Consent Form - COVID 19 & Appointment

By submitting this form, you agree to have services done during the pandemic.
Client Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Zip Code

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By checking the boxes, you confirm that you agree with the following statements:
Do you have any of these symptoms? - cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of taste/smell
Within 14 days, have you been in contact with anyone that has COVID-19 symptoms or get infected?
Did you recently travel (within 14 days from your appointment date) outside Arizona to those states that required self quarantine by the State's order?
I agree not to visit my nail tech for any of the services provided if I have the symptoms of COVID-19.

I acknowledge that the information I have given in this consent form is accurate and complete. By signing below, I confirm that I understand and agree to all terms and statements in this form.
Date

MonthDayYear
Date
Client/Parent/Guardian Signature
Appointment
What kind of service will you be having?
Please make sure to send me an inspo pic of the design wanted.

If wanted add-ons such as rhinestones, cost will vary.
Should be Empty: