Spa Intake Form | Perennial Glow Spa

Covid-19 Health Declaration

Due to the 2019-2020 outbreak of the novel, Coronavirus, COVID-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete the following and submit below.

First Name

Last Name

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, fatigue, cough, chills, difficulty breathing, shortness of breath, sore throat, nausea or vomiting, diarrhea, new loss of taste & smell, new widespread muscle pain, headaches, brusing, readness, swelling or cramping in lower legs and feet, red or purple toes.

I affirm that I, as well as all household members, have not been exposed to anyone diagnosed with COVID-19 within the last 30 days.

Initials

Date

I understand that this business and service professionals cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health histyr provided by each guest.

Thanks for submitting!

All employees of this facility agree that they abide by the same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.

Covid-19 Health Declaration

All employees of this facility agree that they abide by the same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.

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