MYPERFECTBROWS

COVID 19 QUESTIONNAIRE / LIABILITY WAIVER FORM

To ensure the safety of all guests and our team.
THIS FORM MUST BE COMPLETED PRIOR TO SERVICE

WALK IN CLIENTS ARE REQUIRED BY STATE LAW TO WAIT IN THEIR CAR OR AT A SAFE DISTANCE FROM OTHER GUESTS, WHILE WAITING TO BE CALLED FOR SERVICES. *MASKS ARE REQUIRED FOR ENTRY **MASKS ARE AVAILABLE FOR PURCHASE FOR $1 (IF NEEDED). BODY WAXING, EYELASH SERVICES AND FACIAL CLIENTS: PLEASE READ OUR TERMS AND CONDITIONS BEFORE SIGNING.
Name *

First Name Last Name
Phone Number *
Email *
example@example.com
Preferred studio *

CITY OF ORANGE (3130 E. Chapman Ave) LONG BEACH (203 Argonne Ave) SAN JUAN CAPISTRANO (27221 Ortega Hwy) LOS ANGELES (5115 Wilshire Blvd)
Select service(s) below. *

Brow Threading *Brow Waxing Upper Lip Threading *Upper Lip Waxing Side Threading *Side Waxing *Face Threading *Face Waxing *Lash Lift *Lash Extensions *Henna Brows / Tinting *Microblading *Brazilian Waxing *Leg Wax *Arm Wax *Full Body Waxing *Facial Services
CHOOSE A LOCATION BELOW

Because of capacity limits and to ensure the safety of all guests we are inviting you to reserve a 30 min window for your appointment.
ORANGE LOCATION Preferred 30 minute window time slot.
LONG BEACH LOCATION Preferred 30 minute time slot.
SAN JUAN CAPISTRANO LOCATION Preferred 30 minute time slot.
LOS ANGELES LOCATION Preferred 30 minute time slot.
WE ARE DOING OUR PART TO HELP STOP THE SPREAD OF THIS VIRUS. WE FOLLOW ALL RECOMENDATIONS AND ADHERE TO ALL STANDARDS AND GUIDELINES PROVIDED BY THE STATE OF CALIFORNIA.

WE ENCOURGE YOU TO WASH YOUR HANDS BEFORE AND AFTER YOUR VISIT.
Are you experiencing any of the following symptoms? *

FEVER COUGH SHORTNESS OF BREATH CHEST OR BODY PAINS NONE
Have you been in contact, infected, suspected, or diagnosed with Covid-19? *

YES NO
Signature *

Clear
IF YOU ANSWERED YES TO ANY OF THE ABOVE

We will be unable to serve you for the safety of our staff and other guests . visit: www.myperfectbrows.com for additional information or questions.
PROMO CODE (if applicable)
Should be Empty:

COVID 19 QUESTIONNAIRE / LIABILITY WAIVER FORM

THIS FORM MUST BE COMPLETED PRIOR TO SERVICE

CHOOSE A LOCATION BELOW

IF YOU ANSWERED YES TO ANY OF THE ABOVE