COVID-19

Common Symptoms of COVID-19 may include (but not limited to):

Dry Cough, Fatigue/ Tiredness, Fever, Shortness of Breath, Sore Throat, Body Aches/ Pain, Headache, Diarrhea, Nausea or vomiting

More information please visit: https://www.cdc.gov/coronavirus/2019-ncov/index.html

Name

First Name

Last Name

Have you received COVID-19 vaccine?

If you have received COVID-19 vaccine please include date of injection.

This information is only needed if you plan to receive any permanent makeup services. It is advised no tattooing between 1st and 2nd dose of the vaccine and then waiting 10-14 days after the second shot.

I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the last 30 days

please initial

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

please initial

Have you traveled outside the country in the last 30 days?

I understand that this business and artist cannot be held liable for any exposure to the virus or any other contagion cause by misinformation on this form or the health history provided by each client. Furthermore I agree to not hold Cristal Walker or Cristal Walker Beauty LLC if I do contract COVID-19 or any other contagion as I have decided to come here on my own free will for my elective service.

By signing below I agree to each above statement and release Cristal Walker and Cristal Walker Beauty LLC from any and all liability for the unintentional exposure or harm due to COVID-19.

Typing name below will count as signature

Would you like a copy of form emailed?

COVID-19

COVID-19

DUE TO THE PANDEMIC OF NOVEL CORONAVIRUS (COVID19) WE ARE TAKING EXTRA PRECAUTIONS WITH THE INTAKE OF EACH CLIENT