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SF Microblading Covid-19 Informed Consent and Health Declaration
First Name
Last Name
Email
My body temperature is lower than 98.6°F/ 37.5°C
I am not experiencing the symptoms: fever, fatigue, shortness of breath, muscle pain, headache, diarrhea, cough, sore throat, chills, loss of taste or smell, rash
Have you or your immediate family been in contact with a Covid-19 patient in the last 14 days?
*
Yes
No
Have you been diagnosed or suspected of having Coronavirus or Covid-19?
*
Yes
No
Have any of your family members or immediate contacts experienced fever, cough, shortness of breath, flu like symptoms, sore throat, diarrhea, muscle aches, fatigue, or nausea ?
*
Yes
No
I understand that I am choosing an elective beauty service.
I recognize that the team at SF Microblading has put recomended CDC Safety guidelines and preventative measures in place to reduce the spread of this virus. However I understand that with any service, there is a risk of becoming infected with COVID-19 if I proceed with this elective service.
I acknowledge and assume the risk of COVID-19 through this elective service and give my permission for the team at SF Microblading to proceed.
I will notify the team at SF Microblading of any changes at my future appointments.
Initials
Date
I declare that the info I’ve provided is accurate & complete
Submit
Sucess!! Thank you!
Informed Consent
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