Covid Health VerificationCovid Health check Please fill out before your next visit.Name* First Last Phone I have not experienced any of the following symptoms in the last 2 weeks: Cough, fever, difficulty breathing, unusual headaches, sore throat, loss of smell or taste. No one in my household has experienced any of the above symptoms in the last 2 weeks. I have not been diagnosed with or cared for someone diagnosed with COVID-19 in the last 2 weeks. I am coming in with a clear conscience that I am healthy and, to my knowledge, have not been in contact with anyone with COVID-19. I will follow all posted spa rules to keep myself, my practitioner and those around me safe. For those who have previously been diagnosed with COVID-19: I have spoken with my doctor about receiving a massage and he/she has given me permission to do so.Consent I agree to the privacy policy.Date MM slash DD slash YYYY Δ