Revive Medical Aesthetics COVID-19 Form
Please complete this form before arriving for your appointment.
If you answer "YES" to any of the following questions, we must require you to cancel and reschedule your appointment. Last minute cancelations due to COVID-19 will not be charged a cancelation fee.
Our front desk team will be happy to assist you.
Please call 360-425-7712.
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First Name *
Last Name *
Date of Appointment *
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Time
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Who is your appointment with? *
Have you or a member of your household  been asked to self quarantine within the last 14 days? *
Have you or a member of your household tested positive for COVID-19 within the last 14 days? *
Have you had direct contact with someone who tested positive for COVID-19 within the last 14 days? *
Have you experienced any cold or flu symptoms (especially fever,  shortness of breath, cough,  lost of taste or smell) in the last 14 days? *
By completing this form you agree to comply with spa guidlnes and agree that you are at Revive Medical Aesthetcis at your own risk, releasing Revive Medical Aesthetics LLC and all employees from any liability relating to COVID-19. Failure to comply with posted written instructions or verbal instructions from staff may result in your appointment being canceled and 100% charge of the service you were scheduled for.  By typing your name below you agree. *
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