COVID-19 Consent Form

Covid-19 Client Informed Consent Form

First Name

Last Name

I understand that close contact with people increases the risk of infection from COVID-19. By signing this form, I acknowledge that I am aware of the risks involved and give consent to receive massage from this practitioner.

I understand that my name and contact information might be shared with the state health department in the event that a client or practitioner at this facility tests positive for COVID-19. My contact details will only be shared in the event they are relevant based on suspected exposure date, and only for appropriate follow-up by the health department.

As a voluntary participant in this activity; by signing this form, I acknowledge the risks (including but not limited to' physical and psychological injury, pain, suffering, illness, emotional, financial loss and death). By signing this form I hereby waive any and all rights and will not at this time or any time in the future, My attending Therapist, Spa Site or any of its affiliates responsible for any loss or damage regardless of its nature.

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!