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Covid-19 Pre-screening Form
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COVID-19 Pre-Screening
Please complete this form on the day of your appointment. If you don't fill it out online there will be paper forms available in the studio.
I am not experiencing any of these symptoms:
- Fever
- Shortness of breath
- Difficulty breathing
- Chills
- Unexplained fatigue
- Cough
- Sore throat or difficulty swallowing
- Loss of sense of taste or smell
I have not/am not:
- Tested positive for Covid-19 (or are awaiting Covid-19 test results)
- Knowingly been exposed to someone with a confirmed or suspected case of Covid-19
- Recently travelled to an area with a high infection rate
*
Indicates required field
I agree
*
Yes
Name
*
First
Last
Date
*
If you are unwell please stay home & self-isolate right away. Call Telehealth or your health care provider, to find out if you need a test.
Submit
Home
About
Services
Registered Massage Therapy
>
Pregnancy Massage
Body Sugaring
>
Sugaring Rates
Cancellations and Booking Policies
Covid-19 Pre-screening Form
Book Online
Contact