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COVID-19 Pandemic Laser Hair Removal / Skin / Body Treatment Consent Form

EASE MEDSPA & WELLNESS GROUP

We at Ease Medspa & Wellness Group has been following the Center of Disease Control (CDC) guidelines, and implementing Covid-19 Safety Protocols and preventative measures with regard to social distancing practices, expanded sanitizing and disinfection protocols of our spa to reduce the spread of COVID-19; continually keep Ease Medspa & Wellness a safe, compliant and healthy environment. 

We require All individuals (clients and our staff) must keep six feet of distance between ourselves and you, the client, unless performing your service in a private treatment room. 

We require All individuals(clients and our staff) must wear masks to cover both mouth and nose at all times while in Ease Medspa facility. Clients undergoing laser hair removal treatment for face are exempt during the procedure in the treatment room only. 

We require all clients to come alone without bringing anyone who has no appointment at Ease Medspa due to social distance restriction. Our waiting room sitting-area is reduced to 2 sits with social distancing of six feet away from each other. We require everyone to either wash or sanitize hands upon entry, after each treatment or using restroom.

CLIENT CONSENT

By signing this waiver, I agree to knowingly and willingly consenting to have laser hair removal/skin/body service during the COVID-19 pandemic at Ease Medspa Spa & Wellness Group. I confirm that I do not currently have, nor have experienced any of the following symptoms of Covid-19 within the last 14 days:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting, or Diarrhea

  • I confirm that I have not had contact with anyone who has above symptoms, Or anyone that has been diagnosed with Covid-19 within the last 14 days.
  • Upon entering Ease Medspa & Wellness Group, I agree to have a temperature taken using a touchless thermometer and record my temperature in this waiver.
  • If I have a fever over 100.4 degrees fahrenheit, a cough, or any respiratory symptoms, Ease Medspa & Wellness Group reserves the right to refuse service and ask me to leave immediately, and I can rebook my appointment until symptom free for at least 14 days.     

By signing this waiver, I have read and agree to comply with the written instructions and safety guidelines above. I understand all the potential risks, including but not limited to the potential complications related to Covid-19, and I accept the risk and give my permission to proceed with the treatment/procedure at Ease Medspa & Wellness Group; I will not hold Ease Medspa & Wellness Group, and it's employees liable for any symptoms of illness following my contact and visit with Ease Medspa & Wellness Group.

We Ease Medspa & Wellness is doing everything we can do to protect you, our clients, and our staff, and we do need your support!    

Let’s be safe together!

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's temperature

Please type in your temperature *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's temperature

Please type in your temperature *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's temperature

Please type in your temperature *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's temperature

Please type in your temperature *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's temperature

Please type in your temperature *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's temperature

Please type in your temperature *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's temperature

Please type in your temperature *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's temperature

Please type in your temperature *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's temperature

Please type in your temperature *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's temperature

Please type in your temperature *
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's temperature

Please type in your temperature *
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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