Covid-19 Form

Please complete on the day of your appointment, prior to entering.

By completing and submitting this form, you are knowingly and willingly consenting to MONALISA services performed during the COVID-19 Pandemic and you agree to adhere to all safety and sanitation protocols now required by the service provider.

COVID-19 CONSENT FORM

Temperature

COVID-19 Consent: I am aware that due to limited testing for the COVID-19, the virus has a long incubation period during which time carriers of the virus may be asymptomatic (no symptoms) and still be highly contagious. I also acknowledge that it is impossible to determine who has it. I also acknowledge that I understand that anytime I am within close proximity (less than 6ft) of my service provider or any other person, I could have an elevated risk of contracting the virus should it be present. I confirm that I have not experienced any of the following COVID-19 symptoms within the last 2-14 days: Fever, Shortness of Breath, Loss of taste or smell, Dry Cough, Runny Nose, Sore Throat, Chills, Repeated Shaking with Chills, Muscle Pain or Head Ache. I affirm that I have not been exposed to anyone that has been diagnosed with COVID-19 within the past 14 days inside or outside of the country I reside in. I affirm that I have not traveled domestically (outside of my state) or internationally (outside of my country) within the past 14 days.

Digital Signature: I agree by providing my name below, I am in essence rendering my signature in acknowledgement of the completed statements on this form and that all information is accurate as of the date of this form.

COVID-19 Form Complete! Thank you.

COVID-19 FORM

Please complete on the day of your appointment, prior to entering.

By completing and submitting this form, you are knowingly and willingly consenting to MONALISA services performed during the COVID-19 Pandemic and you agree to adhere to all safety and sanitation protocols now required by the service provider.

COVID-19 CONSENT FORM

COVID-19 Consent Form

Client Intake Form

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