*If you have any symptoms or answer NO to any of the questions, I would need to cancel your appointment. If I do not receive this signed form the morning prior to your appointment, I will have to reschedule your appointment.
By signing below I agree to each above statement and release Kellie Campbell and Clear Solutions Acne & Skin Care Clinic from any and all liability for the unintentional exposure or harm due to COVID-19.
I, Kellie Campbell, agree that I abide by these same standards and affirm the same. I also affirm that I have taken an advanced Committed to Health & Safety Infection Control 2 hour online course on 4/30/2020.