Pre-Appointment Waiver & Release

Thank you for scheduling an appointment and entrusting me with your skin’s care. I so look forward to seeing you. Please review and sign this release. And, please, don’t hesitate to email if you have questions prior to your appointment —> kenya@kenyabonvivant.com

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Release of Liability

COVID-19 is a highly contagious virus that spreads from person to person. In addition to long-held and explicit sanitation measures this business has always adhered to, new preventative measures have been put in place to further reduce the spread of this novel coronavirus. However, these best practices still offer no guarantee regarding your potential risk of being infected.
Consent for Treatment
I understand that, because esthetics involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business from any claims related thereto. I give my consent to receive treatment from this practitioner.

COVID-19 Information

I certify that I have NOT had a fever in the last 24 hours of 100°F or above

I certify that I have NOT recently had, any respiratory or flu symptoms, sore throat, or shortness of breath

I certify that I have NOT been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus- type symptoms

Date *

Your Full Name *

Email *

Phone *

Agree to Terms

I declare that I am at least 18 years of age. I ahve read and agree with the terms outlined above.

Signature

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