Health Declaration Form

Our priority is your well-being and safety. Before you indulge in our services, we kindly request you to complete our easy Health Declaration form.

First name

Last name

Phone

THESE ARE ALL REQUIRED CHECKBOXES

My body heat is lower than 99.5°F/ 37.5°C.

I don’t have any of these symptoms: fever, cough or sore throat.

I wasn’t in close contact with a COVID-19 patient in the last 14 days.

I declare that the statements above are true.

NO-SHOW/LATE/RESCHEDULE POLICY

I understand, if I do not show up for my appointment, within a 10-minute grace period, I will need to reschedule and I will forfeit my payment. I understand if I do not cancel my appointment 48 hours, or more, before my scheduled time, I will forfeit my payment. Appointment changes can be made via text, email, or on app. NO EXCEPTIONS please.

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