Inner Image Covid-19 Guidelines and Policy Agreement

IMPORTANT! ACTION REQUIRED PRIOR TO YOUR NEXT INNER IMAGE APPOINTMENT.

During this unprecedented time, we are taking additional safety measures within our facility to create a safe environment for you and all our clients.

We ask you to participate by reading and agreeing to the updated guidelines Please carefully read and sign this document to help us in creating a “new norm” during your visit at Inner Image.

To keep your scheduled appointment, we ask you to sign this Guideline and Policy Agreement and send it back to us within; 48 hours. We apologize for the inconvenience and strict nature, but without a commitment to our guidelines we will have to cancel your appointment and reschedule it during a safer time.

The following steps are being taken to protect you and our staff:

1. We are screening anyone who enters the office and taking temperatures.
2. All providers will be outfitted with the additional protective gear for your procedure.
3. While we pride ourselves on always keeping our environment clean and sterilized, be reassured that each treatment room along with all equipment is deep cleaned between each client, and we are following the CDC’s Standard Precautions Guidelines and OSHA requirements. 
4. All common areas and surfaces will be cleaned 3-4 times throughout the day.

To help us with further containment please adhere to the following:

Before Coming to the Office

Before leaving to come to your appointment, please screen for symptoms. If you or anyone in your household have symptoms of a cold, flu, or if you recognize symptoms of COVID 19 (fever, cough, or shortness of breath) call and cancel your appointment.  We are currently enforcing a zero-tolerance policy and will be happy to reschedule your appointment as a priority once you are 14 days symptom free.

Before Entering the Office

• Leave all belongings in your car, with exception of your car keys, phone, credit card and driver’s license.  This includes your jacket, wallet, hats, computers, animals, reading materials etc. 
• Please enter the building with a mask on.  Unfortunately, we are currently unable to provide clients with masks.
• If possible, please use the restroom before your appointment. 
• Upon entering the office there will be a sign on the door with instructions and supplies: Alcohol for shoes and hand sanitizer.

In the Office

• Check-in at the front desk to have your temperature taken – the window will remain closed most of the time
• Please use respiratory etiquette – covering coughs, and sneezes.
• Our waiting area has chairs placed adequately apart for social distancing.
• If you must use the restroom, please utilize the cleaning agents provided and wash your hands before exiting.
• We are unable to use blankets but will provide space heaters for your comfort.

Please Agree

We appreciate your understanding and flexibility during these challenging times.  Our goal is to keep you safe while providing excellent care.  If you have any further questions or concerns, please contact us directly and we will be happy to speak with you.

I agree to adhere to Inner Image guidelines to the best of my ability. I am committed to using respiratory etiquette and will reschedule my appointments if I show signs and symptoms of COVID -19.
I understand my electronic signature is the online equivalent of an ink-on-paper signature signifies my understanding, acceptance, and authorization of the conditions of this legal document.

Please sign by typing your name in ALL CAPS: (required)

Covid 19 Liability Waiver

Warning of Risks & Assumptions of Risks:

I understand participating in elective cosmetic procedures involves inherent health risks. There is risk of exposure to COVID-19 when leaving one's home, and all medical and cosmetic procedures have some degree of inherent risk, including unknown risk. Though minimal when your provider is wearing full Protective Equipment, there is a risk whenever the skin in broken or treated. By consenting to treatment during the COVID-19 pandemic, I acknowledge that I understand the risk of treatment at Inner Image facility and I voluntarily accept all health risks.

Waiver, Release, and Indemnification:

I understand and acknowledge that no person or entity ensures my safety. I assume full and complete responsibility for any illness which may occur at Inner Image facility. I hereby release, waive, hold harmless and covenant not to file suit against the administrators, employees, medical staff, or any affiliated individuals associated with your treatment from any and all loses, damages, liabilities or other claims and caused of action that may arise out of my treatment at Inner Image.This waiver shall bind a minor client if agreed to by that minor's parent of legal guardian.

Please sign by typing your name in ALL CAPS: (required)

Your Email (required)

For More information please go to:www.cdc.gov/COVID19