Form #2

Allure Beauty Lounge 

917 West 18th Street
Chicago,IL 60608 
Phone Number: 312.521.0471 
Website: www.allurebeautylounge.com 
Email: info@allurebeautylounge.com

COVID-19 Pandemic Treatment Consent Form.I knowingly and willing consent to have esthetician treatment(s) during the COVID-19 pandemic.

I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not, given the current limits in virus testing. 


 I understand that due to the frequency of visits and other clients, the characteristics of the virus, and the characteristics of treatments, that I have an elevated risk of contracting the virus simply by being in a salon.
 
I confirm that I am not presenting any of the following symptoms of COVID-19 listed below: 
 
Fever – Temperature: degrees
Shortness of Breath
Loss of Sense of Taste
Loss of Sense of Smell
Dry Cough
Runny Nose
Sore Throat

To prevent the spread of contagious viruses and to help protect each other, I understand that I will have to follow the salon’s strict guidelines. 
 
(initial)

I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus, and I understand that the CDC, OSHA and the Board of Cosmetology and Barbers recommend social distancing of at least 6 feet. 
I verify that I have not traveled outside the United States in the past 14 days to countries that have been affected by COVID-19. 

 I verify that I have not traveled domestically within the United States by commercial airline, bus or train within the past 14 days.