Lash Fox | Covid-19 Pre-Appointment Screening

Name *

First

Last

Email *

Phone *

I understand the above symptoms and confirm that I, as well as my household members, DO NOT currently have, nor have experienced the symptoms listed above within the last 14 days. *

Yes
No

I confirm that I, as well as all household members, have NOT been diagnosed with COVID-19 within the last 14 days, and have NOT knowingly been exposed to anyone diagnosed with COVID-19 within the last 14 days. *

Yes
No

I confirm that I, as well as all household members, have NOT traveled outside of the country, or to any city outside of our own that has been considered a "hot spot" for COVID-19 infections within the last 21 days. *

Yes
No

I understand that this studio screens all clients and team members for possible COVID-19 per the current guidelines. However, carriers of the virus may be completely asymptomatic as the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be contagious. Some may never develop severe symptoms. While this studio strictly adheres to IHA, Federal and Provincial Health Authority standards as they currently exist, COVID-19 is a new highly contagious pathogen that can be transmitted to and from the spa, health, and wellness professionals even under strictly followed standards. This virus can be spread through droplets or contact. *

Yes
No

I understand that due to other clients visiting the studio for treatments and due to the characteristics of the virus, I have an elevated risk of contracting the virus simply by being in the studio. *

Yes
No

I understand the Provincial Health Authority recommends physical distancing of at least 6 feet, and this is not possible when seeking beauty treatments. *

Yes
No

I understand that this business and my esthetician 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. *

Yes
No

If you have answered 'No' to any of these questions please contact Lash Fox Beauty immediately to reschedule.

Text or Call 778-760-4300

Signature - By signing below I agree to each above statement and release the esthetician and business from any and all liability for the unintentional exposure or harm due to COVID-19. *

Your esthetician and all team members of this facility agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions. Your information will not be sold or used for any purpose beyond contact tracing, should the need arise.

Todays Date *