COVID 19 LV NAILS SERVICES CONSENT FORM. ANSWERING THESE QUESTIONS IS REQUIRED BY LAWS TO START THE SERVICES.
LV NAILS AND SPA DOWNINGTOWN. Please note that this health consent form is for the appointment that you already booked. If you did not have appointment, please call 4848811617 or 6102697700 to make your appointment.
YOUR FULL NAME:
YOUR ADDRESS STREET AND CITY:
Example: 700 S High St, West Chester
YOUR PHONE NUMBER:
YOUR APPOINTMENT TIME:
Please note that this Appointment time section is for the appointment that you already booked. If you did not have appointment yet, please call 4848811617 or 6102697700 to make your appointment.
MEDICAL CONDITION: Do you currently have, or have you had any of the following conditions?
Shortness of breath/difficulty breathing
New loss of taste or smell
None of the ABOVE
*Do you have knowledge of, or have you had close contact in the past 14 days with anyone who has been diagnosed with COVID-19?
*Have you been in an area with a known risk of reported cases of COVID-19?
Please understand that if you have any combination of the above, we may have to ask you to leave and report to your healthcare provider.
CONSENT TO SERVICE: By signing below, you agree the following: I have been fully informed of the risks of service including but not limited to infection, scarring, melanomas, allergic reaction to service, latex gloves, and antibiotics. Having been informed of the potential risks associated with getting service at LV NAILS AND SPA DOWNINGTOWN.
Please Read Everything Carefully!!!
I hereby agree to waive all liabilities towards LV NAILS AND SPA INC and their EMPLOYEES for anything that happens during or after my service is finished.
I hereby certify to the best of my ability and knowledge to inform of any changes in the above information, that I have read, and agree that the information I have provided is complete and true to the best of my knowledge.
Client Signature: Print Your Name!
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service