Health Declaration / Waiver Form

First Name

Last Name

Cell Phone

Any known allergies/medical conditions

I understand that I have a risk of contracting virus during the service. I agree to obey the rules of the salon during my appointment to minimize the spread of viruses. I agree to not visit the salon for any of the services provided if I have symptoms of COVID-19 or possibility of having any other contagious illnesses.

I have reviewed and aware of the risk of receiving chemical services. I understand that a patch test is recommended, and by avoiding a testing, I waive my right to hold Yuki and THE SALON LEPETIE to be responsible for all adverse health reactions from this service, or for any undesired results of the treatment.View Risks

*If you would like to request for a patch test, please contact Yuki to schedule for a testing. A test must be performed 24-48hrs prior to the appointment. The service cannot be performed on the same day.

I acknowledge that the information I have given in this form is accurate and complete. By signing below, I confirm that I understand and agree to all terms and statements in this form.

By typing your name below, you are signing this form electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.

Date

Health Declaration / Waiver Form

*If you would like to request for a patch test, please contact Yuki to schedule for a testing. A test must be performed 24-48hrs prior to the appointment. The service cannot be performed on the same day.

I acknowledge that the information I have given in this form is accurate and complete. By signing below, I confirm that I understand and agree to all terms and statements in this form.

THE SALON LEPETIE
610 Santa Monica Blvd, Ste 202
Santa Monica, CA 90401

Los Angeles, California, USA