• Covid-19 Pandemic Gangnam Spa LLC Services Consent Form

  • I, knowingly and willingly consent to have services performed by staff of Gangnam Spa LLC during the COVID-19 pandemic. I understand that I am opting for a service that is not urgent and not medically necessary. 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, given the current limits in virus testing.      (Initials)

    I recognize that the staff at Gangnam Spa LLC are closely monitoring this situation and have put in place reasonable preventive measure targeted to reduce the spread of this virus. However giving the nature of this virus, I understand there is inherent risk of becoming infected with Covid-19 if I proceed with this elective service.

    I understand that even if I have been tested for Covid-19 and receive 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 this business and professional offering the service responsible for any liability related to Covid-19 and any variation or mutation thereof.

    I confirm that I am not presenting any of the following systems of COVID-19 included but not limited to the following list.       (Initials)

    • Fever – temperature
    • Shortness of breath
    • Loss of sense of taste or smell
    • Dry cough
    • Runny nose
    • Sore throat


    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.      (initial)

    I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus.    (initial)

    I understand that the CDC, OSHA and Missouri Board of Cosmetology and Barbers recommend social distancing of at least 6 feet.    (initial)

    I verify that I have or have not (circle one) traveled outside the United States in the past 14 days to countries that have been affected by COVID-19.    (initial)

    I verify that I have or have not (circle one) traveled domestically within the United State by commercial airline, bus, or train within the past 14 days.      (initial) If you have, please list:     

    Appointment date:     
    Pick a Date   

    Client Signature:      

    Print name:         Today's date:   

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