New Client Consultation Form

COVID-19 Pandemic Salon Service Treatment Consent Form

Intelli Beauty System LLC dba M Beauty Studio / M Lash
Date *

Month Day Year
Name *

First Name Last Name
Phone Number

Area Code Phone Number
I knowingly and willingly consent to having salon service(s) during the COVID-19 pandemic. *

by checking this box I understand and accept this statement.
To prevent the spread of contagious viruses and to help protect each other, I understand that i will have to follow the salon's strict guidelines. *

by checking this box I understand and accept this statement.
I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of salon services, that I have elevated the risk of contracting the virus by merely being in the salon. *

by checking this box I understand and accept this statement.
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 give the current limits in virus testing. *

by checking this box I understand and accept this statement.
I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. I know that the CDC, OSHA, and Connecticut state board of cosmetology recommend social distancing of at least 6 feet. *

by checking this box I understand and accept this statement.
I confirm that I am not presenting any of the following symptoms of COVOID-19 listed below:• Temperature above 100.4 degrees• Shortness of breath• Loss of sense of taste or smell• Dry cough• Sore Throat *

by checking this box I understand and accept this statement.
I do not believe that I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. *

by checking this box I understand and accept this statement.
I verify that I have not traveled outside the United States In the past 14 days to countries that have been affected by COVID-19 *

YES NO
I confirm that I have not traveled domestically within the United States by commercial airline, bus or train within the past 14 days *

YES NO
I understand, read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that this document is to provide the best possible guest experience when visiting M Beauty Studio / M Lash. *

Yes
By signing below, I hereby release and agree to hold Intelli Beauty System LLC harmless from any liability due to Covid-19.
Signature *

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COVID-19 Pandemic Salon Service Treatment Consent Form