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COVID-19 Tattoo Consent Survey Form
Please fill out the form
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Full Name:
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First Name
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Last Name
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Date:
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The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
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Name of Tattooist for upcoming visit :
Dick
Chris
John
Beetle
Shai
Anyone
Not Sure
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I knowingly and willingly consent to having tattoo service(s) during the COVID-19 pandemic.
By checking this box I understand and accept the statement.
By checking this box I understand and accept the statement.
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To prevent the spread of contagious viruses and to help protect each other, I understand that i will have to follow the tattoo shops strict guidelines
By checking this box I understand and accept the statement.
By checking this box I understand and accept the statement.
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I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. I know that the CDC and OSHA recommend social distancing of at least 6 feet.
By checking this box I understand and accept the statement.
By checking this box I understand and accept the statement.
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I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of tattoo services, that I have elevated the risk of contracting the virus by merely being in the salon company.
By checking this box I understand and accept the statement.
By checking this box I understand and accept the statement.
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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 give the current limits in virus testing.
By checking this box I understand and accept the statement.
By checking this box I understand and accept the statement.
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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:
Yes
No
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I confirm that I have or have not traveled domestically within the United States by commercial airline, bus or train within the past 14 days :
Yes
No
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Tattoo Shop Symptoms Policy
I agree not to come to the Tattoo Shop with the following symptoms of COVID-19 listed below: Fever- Temperature Shortness of breath Loss of sense of taste or smell Dry cough Runny nose Sore throat
I understand, read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that this document is to provide the best possible guest ex
Yes
Yes
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Signature:
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Submit