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Covid-19 Informed Consent
I, the client
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understand that I am opting for a service that is not urgent and not medically necessary.
also understand that the coronavirus disease (COVID-19) has been declared a worldwide pandemic by the World Health Organization. I further understand COVID-19 is extremely contagious. State and federal health agencies recommend social distancing. I recognize that the staff at are closely monitoring this situation and have put in place reasonable preventive measures targeted to reduce the spread of this virus. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 if I proceed with this elective service.
acknowledge and assume the risk of becoming infected with COVID-19, and any variation or mutation thereof, through this elective service and I gave my express permission for the staff at to proceed with the same. This consent applies to any follow up or additional services in the upcoming months.
understand that even if I have been tested for COVID-19 and received a negative test result, the tests may not have detected the virus or I may have contracted COVID-19 after the test. I will not hold this business and professional offering the service responsible for any liability related to COVID-19 and any variation or mutation thereof.
understand that exposure to COVID-19 before, during, or after my procedure(s) may result in complications and/or delayed healing. I have been given the option to defer my service to a later date. However, I understand all the risks including those noted herein and I would like to proceed with this service. I can ask to have a copy of this consent form emailed to me and have access to this consent form at jessicadevereux.com.
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I, the client, submit my typed name below as my electronic signature that I understand the explanation of risks related to Covid 19, release Brow and Lash Specialist - Jessica Devereux of all liability, and consent to the procedure during the Covid 19 pandemic. (If the client is under 18) I, the parent/guardian of the client submit my typed name below as my electronic signature that I understand the explanation of the risks related to Covid 19, release Brow and Lash Specialist - Jessica Devereux of all liability and consent to the procedure during the Covid 19 pandemic.
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Service Consent Form
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Any known allergies to latex, hair color, bandaids, cyanoacrylate or skincare ingredients? If yes, please list; otherwise, type no.
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Are you currently taking or using antibiotics, supplements, Accutane, retin-A, Renova, blood thinners,Insulin? If yes, please list; otherwise, type no.
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Please list any illness/condition you are currently being treated for by a medical professional. If none, please type none.
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I, the client
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understand that the potential risks involved with depilation include but are not limited to skin removal, redness, swelling, pimples and tenderness.
understand that the potential risks related to lash extension adhesive, henna, eye and skin cleansers, and debonding solutions include but are not limited to redness, irritation, and swelling. The products used may release fumes and can cause my eyes to water.
understand that Jessica Devereux will take every precaution to minimize or eliminate any negative reactions.
understand that allergies do not only occur immediately, but can develop after many services over time with exposure. If any unusual symptoms, injury or allergy is suspected, all future appointments will cease until cleared by your physician.
understand that I have access to all detailed service information and aftercare information at jessicadevereux.com.
understand that in the event that I may have additional questions or concerns regarding my treatment, I understand that I am welcome to contact Jessica Devereux.
have answered my medical questions listed above, and will disclose changes at the beginning of any future service.
I, the client, submit my typed name below as my electronic signature that I understand the potential risk involved with any elective service, I release Brow and Lash Specialist - Jessica Devereux of all liability and consent to the procedure(s). (If the client is under 18) I, the parent/guardian, submit my typed name below as my electronic signature that I understand the potential risk involved with any elective service, I release Brow and Lash Specialist - Jessica Devereux of all liability and I consent to the procedure(s).
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all forms must be submitted before service
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