covid

I understand that I am opting for an elective service at Wisp Lashes.

I also understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. I further understand that COVID-19 is extremely contagious and is believed to spread by person-to-person contact; and, as a result, federal and state health agencies recommend social distancing. I recognize that my service provider and all the staff at Wisp Lashes are closely monitoring this situation and have put in place reasonable preventative measures aimed to reduce the spread of COVID-19. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 by virtue of proceeding with this elective service. I hereby acknowledge and assume the risk of becoming infected with COVID-19 through this elective service, and I give my express permission for my service provider and all the staff at Wisp Lashes to proceed with the same.

I understand that, even if I have been tested for COVID and received a negative test result, the tests in some cases may fail to detect the virus or I may have contracted COVID after the test.

I understand that possible exposure to COVID-19 before/during/after my service may result in the following: a positive COVID-19 diagnosis, extended quarantine/self-isolation, additional tests, hospitalization that may require medical therapy, Intensive Care treatment, possible need for intubation/ventilator support, short-term or long-term intubation, other potential complications, and the risk of death.

I understand that COVID-19 may cause additional risks, some or many of which may not currently be known at this time, in addition to the risks described herein, as well as those risks for the service itself.

I understand all the potential risks, including but not limited to the potential short-term and long-term complications related to COVID-19, and I would like to proceed with my desired service.

I understand the explanation and have no more question and consent to the service

    Name:
    Date:
    Email:
    In the last 14 days, have you had a fever?
    In the last 14 days, have you had a cough?
    In the last 14 days, have you been around anyone with a cough or fever?
    Are you living with anyone who is currently sick or quarantined due to COVID-19?
    Signature: