Covid-19 Service Consent Form

Covid-19 Service Consent Form
Name

First Name Last Name
Date

Month Day Year
Date
Appointment
By checking these boxes you confirm that you agree with the following statements.

I have quarantined for at least 10 days if I have been out of the state. I have not been exposed to anyone with Covid 19, I have quarantined for at least 14 days if I have been exposed to someone with the Covid-19 Virus. I have not been diagnosed with Covid-19 in the last 14 days. I am not experiencing any symptoms of Covid-19. In order to receive facial services, I understand that my mask will be off for the duration of the service.
Signature

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