COVID-19 & Liability Waiver | amyzingaesthetics

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

I have not had a fever in the last 24 hours of 100°F or above

I am not experiencing the symptoms: fever, cough, sore throat

I have not been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has corona virus type symptoms

Consent for Treatment

I understand that, because esthetics involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business from any claims related thereto.

I agree to the terms & give my consent to receive treatment from this practitioner.

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

amyzing aesthetics

Covid-19 Health Declaration