Please ensure you complete the Permanent/Paramedical Cosmetics Consent form in full. If you've previously completed a form for the same area and concern, you don't need to redo it. We'll review and update it when you arrive. Thank you for your cooperation!

Takes 7+ minutes

Question 1

Precautionary Covid-19 Liability Release Form

Due to the outbreak of the Corona Virus/COVID-19, I am taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete and type your name below. You will be required to review, update, and sign your name at your appointment.

I agree to the following:
I have not had any communicable illnesses in the last 14 days, including but not limited to Covid-19 related symptoms.

Symptoms of COVID-19 include:
- Fever
- Fatigue
- Dry Cough
- Sore Throat
- Muscle Pain
- Headache
- Chills
- Difficulty Breathing
- New loss of Taste or Smell

I understand that a mask may be required and that the staff at Blissful Image will be wearing a mask throughout the duration of my appointment. If I do not have a mask, one will be provided to me and I agree to comply.

I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.

I understand that Blissful Image and my Provider Sharlyn Cruz-Marquez will not 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 typing my name below, I agree to each above statement and release Sharlyn Cruz-Marquez & Blissful Image from any and all liability for the unintentional exposure or harm due to COVID-19.

As your Licensed Esthetician/PMU & Body Contour Provider, I abide by these same standards and affirm the same. I also affirm that I have improved and expanded my sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.This question is required.

Type your name below: