Covid-19 Client Consent Form

Client Name*

First NameLast Name

Date of Birthday*

Date

I understand that I have a risk of contracting virus during the treatment.I agree to obey the rules of the business during my appointment in order to minimize the spread of viruses.I confirm that I have not been diagnosed with COVID-19 last 14 days.I verify that I am not waiting for the laboratory test results for COVID-19.

YesNo

If yes please let us know the date:*

Date

YesNo

I understand that COVID 19 is highly contagious ant still present in the community where I am seeking treatment.

I understand that COVID 19 is passed through close contact with other and that people without symptoms may be infectious.

I understand that Shanti Holistic Therapies has taken every precaution to ensure my health and safety.

I agree not to visit the space for any of the treatments provided if I have the symptoms of COVID-19.

I acknowledge that the information I have given in this consent form is accurate and complete.

I also understand that my personal details will be held securely under GDPR and may be used for Contact Tracking process if necessary.

By signing below, I confirm that I understand and agree to all terms and statements in this form.

Parent/Guardian Name (if applicable)

First NameLast Name

Date*

Date

Client/Parent/Guardian Signature*