INFORMED CONSENT | E&S Lounge

INFORMED CONSENT - COVID-19 PANDEMIC

First Name

Last Name

I understand that I am opting for a service that is not urgent and not medically necessary.

I will not hold this business and professional offering the service responsible for any liability related to COVID-19 and any variation or mutation thereof, and I understand that exposure to COVID-19 before, during, or after my procedure(s) may result in complications and/or delayed healing.

I acknowledge and assume the risk of becoming infected with COVID-19, and any variation or mutation therof, through this elective service and I give my express permission for the staff at E&S Lounge to proceed with the same. The consent applies to any follow up or additional services in the upcoming months.

I have been given the option to defer my service to a later date. However, I understand all the risks including those noted herein and I would like to proceed with this service. I acknowledge I can get a copy of this consent form from E&S Lounge.

Initials

Date

I understand the explanation and consent to the procedure.

Thanks for submitting!