Welcome to Brows by Laurie! I am looking forward to seeing you at your upcoming appointment. In preparation, I ask that you carefully read through and complete our COVID-19 infomed conent from and pre-screening questionnaire. Please do not hesitate to let me know if you have any additional questions or concerns.
COVID-19 Informed Consent Agreement
I am aware that exposure to COVID-19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death.
I understand in-person services increase the risk of my transmission of COVID-19 to my Service Provider and staff. This virus has a long incubation period, there may be as yet unknown aspects of its transmission, and I realize that I may be contagious, whether or not I have been tested or have symptoms.
To reduce the possibility of COVID-19 exposure or transmission at Brows by Laurie I accept that my Service Provider will implement infection-control procedures with which I must comply with during my service, for my own protection as well as that of my Service Provider.
I understand my cooperation is mandatory, whether or not I personally feel such COVID-19 procedures and/or preventive measures are necessary.
I have read this COVID-19 Informed Consent Agreement and am authorized to consent on my behalf.
Client Signature:
May 26, 2022
Are you currently experiencing any of these symptoms? Choose any/all that are new, worsening, and not related to other known causes or conditions you already have.