True Skin Laser Spa
I have confirm that I have not been on any antibiotics, or anything that can make me light sensitive, in the last 10 days, and there is no changes to my medical history on file.
I have not been on antibiotics
I have been on antibiotics
If I am having an IPL treatment, I have not been using any products using Retin-A for the past 4 days
I am not using any products with Retin-A for at least 4 days
I am using products with Retin-A
I am not having an IPL
Myself, and everyone in my household, has not had a fever, or other illness symptoms, in the last 48 hours.
I (we) have been healthy for the last 48 hours
I have experienced a fever or other illness symptoms
Someone in my household has experienced a fever or other illness symptoms
Myself, and everyone in my household, have not been exposed to anyone with confirmed COVID-19 in the last 14 days.
We have not been exposed to my knowledge
Myself, or someone in my household, has recently been exposed
Thank you for your continued trust in our business. As with the transmission of any communicable disease like a cold, or the flu, you may be exposed to COVID-19, also known as the "Coronavirus," at any time or in any place. Be assured that we have always followed state, federal, and CDC regulations and recommended disinfection protocols to limit transmission of all diseases in our spa, and continue to do so. Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our spa, just as you might be at your gym, grocery store, or favorite restaurant. "Social Distancing" nationwide has reduced the transmission of Coronavirus. Although we have taken measures to provide social distancing in our practice, due to the nature of the treatments we provide, it is not possible to maintain social distancing between client, technician, spa staff, and sometimes other clients at all times. Although exposure is unlikely, by signing your name you accept the risk and consent to treatment. Please check, "I accept" and sign your name and date at the bottom of the form.
I do not accept and wish to cancel my appointment
Please sign and date (MM/DD/YYYY) below (Your full name must be included)
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