The Looking Glass Esthetics Studio
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Risk Acknowledgment Form-Covid-19
*
Indicates required field
Date
*
Name
*
First
Last
Address
*
Phone Number
*
I confirm that I am not presenting any of the following symptoms of COVID-19 listed below: • Temperature above 98.7 degrees • Shortness of breath • Loss of sense of taste or smell • Dry cough • Sore Throat *
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Yes
No
I confirm to cancel all appointments at the studio if any symptoms develop, if I am required to self-isolate, or if I knowingly had close contact with someone who is confirmed or suspected of COVID-19.
*
I confirmed
All personal information will be kept completely confidential by The Looking Glass & shall only be provided if requested by PEI health officials for contact tracing if required.
*
I understand and agree for the above information to be access by Health officials if required for Covid-19 contact tracing only.
Submit
Gift Cards
About
Testimonials from Spa Clients
Skin Treatments
Pedicures & Manicures
Waxing
Relaxation Massage
Dermalogica Products
Purchase Gift Cards Online
Contact
Online Booking