COVID-19 Consent Form
Date of Service
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Month
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Day
Year
Date Picker Icon
Name
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First Name
Last Name
Phone Number
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Area Code
Phone Number
Appointment Time
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1
2
3
4
5
6
7
8
9
10
11
12
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Hour
00
15
30
45
Minutes
AM
PM
AM/PM Option
Location of Service
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Mountain View
Sunnyvale
Service Requested
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No Polish Manicure
No Polish Pedicure
Gel Manicure
Gel Pedicure
Artificial Nails
Eyelash Extensions
Waxing
Facial
I knowingly and willingly consent to having nails, pedicure, eyelash extensions and other salon service(s) in a location outside of our normal establishment due the COVID-19 pandemic
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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
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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 California State Board of Cosmetology recommend social distancing of at least 6 feet.
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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 close nature of all salon services, that I have elevated the risk of contracting the virus by merely being in the salon company.
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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.
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By checking this box I understand and accept this statement.
I confirm that I have not traveled outside the United States In the past 14 days to countries that have been affected by COVID-19
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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
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YES
NO
I’m willing to have my temperature check during my visit to OMG! Nails & Spa before the services are started. I agree to cancel or reschedule my appointment if I have the following symptoms related to COVID-19 listed below: Fever, high temperature, shortness of breath, loss of sense of taste or smell, dry cough, runny nose, sore throat and other symptoms similar, but not limited to the flu.
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By checking this box I understand and accept this statement.
I have read and understand 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 OMG! Nails & Spa
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Yes
Signature
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Submit
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