Medical Waiver for Contagious Diseases and Illnesses

Medical Waiver for Contagious Diseases and Illnesses
Name

First Name Last Name
Date

Month Day Year
I am aware of the current medical issues and concerns that are facing all of us today, and agree to let you spa staff member at Flawless Spa Retreat of Distinction know if any of the following are true about me:
1) I have not traveled internationally outside the United States at any time, for any length of in the last 45 days.
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2) I have not been exposed to, or around anyone with Coronavirus, also known as COVID 19, at any to my knowledge.
Please initial
3) If I was subject to a mandatory or voluntary quarantine for any reason, I completed that quarantine for a minimum of 14 days and showed no signs of illness during that 14 days.
Please initial
4) I am not now showing any signs of flu or other sickness that has symptoms similar to the flu or related to COVID 19 or pneumonia. They include: a. Fever, sudden onset fever or low-grade persistent fever b. Nausea c. Excessive sinus drainage beyond typical allergies d. Sore throat e. Dry cough f.Chills difficult to control g. Shortness of breath h. Persistent pain or pressure in my chest
Please initial
I understand that if any of the following are true that I may not be seen today, and my appointment may be rescheduled to a later time.

I have read and understand the above and agree to notify Flawless Spa Retreat of Distinction if I am currently suffering from any of the above.
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