MS. VEE'S BEAUTY LAB Services Consent Form - COVID 19 Pandemic
By submitting this form, you agree to have manicure or pedicure services during the pandemic.
Client Name
*
First Name
Last Name
Zip Code
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
By checking the boxes, you confirm that you agree with the following statements:
*
I agree to follow the rules of the salon during my appointment in order to minimize the spread of viruses.
I confirm that I have not been diagnosed with COVID-19 last 14 days.
I verify that I am not waiting for the laboratory test results for COVID-19.
I voluntarily seek services provided by HQ Nails Salon LLC and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19.
I’m willing to take a temperature check during my visit to the salon before the services are started.
Do you have any of these symptoms? - cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of taste/smell
*
Yes
No
Within 14 days, have you been in contact with anyone that has COVID-19 symptoms or get infected?
*
Yes
No
Are you living with anyone that is get infected or quarantined due to COVID-19?
*
Yes
No
Did you recently travel (within 14 days from your appointment date) outside New Jersey to those states that required self quarantine by the State's order?
*
Yes
No
I agree
not
to visit the salon 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
*
-
Month
-
Day
Year
Date
Client/Parent/Guardian Signature
*
Should be Empty: