COVID-19 Treatment Consent

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Home
About
Services
Forms
- Client Consultation Form
- COVID-19 Treatment Consent
Book
Blog
eGift Card
Contact

COVID-19 Treatment Consent

Please take a moment to complete our consent form.

By submitting the form below you agree to knowingly and willingly consent to have skin/body service during the COVID-19 pandemic.

We reserve the right to refuse service if this form is not submitted. Thank you.

First Name

Last Name

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.

Yes

I understand that it is impossible to determine who has COVID-19 and who does not, given the current limits in virus testing.

Yes

I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of skin/body services, that I have an elevated risk of contracting the virus simply by being in the lounge.

Yes

I confirm that I am not presenting any of the following symptoms of COVOID-19 listed below:

Temperature above 98.7 degrees

Shortness of breath

Loss of sense of taste or smell

Dry cough

Sore throat

Body aches and chills

I Am Not Presenting Symptoms

None

I confirm that I have not been around anyone with these symptoms in the past 14 days.

I Do Not

I do not live with anyone who is sick or quarantined.

I Do Not

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.

Yes

I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus.

Yes

I understand that the CDC, OSHA, and Texas Board of Cosmetology recommend social distancing of at least 6 feet.

Yes

I verify that I have not traveled outside the United States in the past 14 days to countries that have been affected by COVID-19.

Yes

I verify that I have not traveled domestically within the United States by commercial airline, bus, or train within the past 14 days.

Yes

Date

Please type your full name below. By typing and submitting, this serves as a Digital Signature and verifies that you fully agree to our safety policy for our services. This digital signature holds the same authority as a handwritten one. Thank you.

Thank you for contacting us.
We will get back to you as soon as possible.

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4303 S Bowen Road #127
Arlington, TX 76016

TextUs

817-614-0880
info@sereiaskinlounge.com

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Hours of Operation

Monday - Closed
Tuesday - Friday 9am - 8pm
Saturday - 9am - 6pm
Sunday - 10am-5pm

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