I attest that as of this date, I have not experienced any of the following symptoms within the last 14 days:
Fever or chills
Shortness of breath or difficulty breathing
Muscle or body aches
New loss of taste or smell
Congestion or runny nose
Nausea or vomiting
Please read and check each box to agree to the statement:
I understand the above symptoms and affirm that I, as well as all household members and co-workers, do not currently have, nor have experienced any symptoms listed above within the last 14 days.
I, as well as household members and co-workers, have not been diagnosed with COVID-19 in the last 60 days.
I, as well as household members and co-workers, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 60 days.
I, as well as household members and co-workers, have not traveled outside of the country, or to any city outside of their own that is or has been considered a “hot spot” for COVID-19 infections in the last 30 days.
I understand that Natrabella Skincare LLC and its staff of course cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client.
By signing below, I agree to each above statement and release Natrabella Skincare LLC from any and all liability for the unintentional exposure due to COVID-19. All our employees agree and abide by these same standards and attest the same.