COVID-19 Pre-Appointment Intake Form

Due to the Covid-19 outbreak we are taking extra precautions with the intake of each client, health history review, as well as increased sanitation and disinfecting practices. We are taking the needed and recommended measures on our end to ensure the safety of both ourselves and our clients.

Symptoms of COVID-19 include: Fever, Chills/Shakes, Difficulty Breathing, Dry Cough, Sore Throat, Sneezing & Skin rashes.

We will be seeing clients on an appointment only basis. This COVID-19 waiver must be reviewed and signed prior to coming in for your appointment. If you are under 18 a parent/guardian must sign for you.

We are also not allowing client's "guests" to sit in the waiting room during their appointment. Thankfully we have a beautiful downtown to venture through while the client receives their treatment.

Our therapists will be wearing the appropriate PPE as needed.

We are so excited to welcome all of our clients back to LH Spa & Rejuvenation and want to ensure everyone's safety.

I understand the COVID-19 symptoms listed above and affirm that I, as well as my household members, DO NOT currently have, nor have experienced the symptoms listed above within the last 21 days.

I affirm that I, as well as all household members, have not traveled outside of the country, or to any

I understand the CDC recommends physical distancing of at least 6 feet, and this is not possible when seeking services in our spa.

I understand that I will need to call in prior to arrival, and have my temperature taking prior to entering the spa.

I understand that LH Spa & Rejuvenation and your therapists cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the client intake form.

I understand carriers of this virus may be non-symptomatic and may still be contagious. I agree to treatment given this fact and realize LH Spa & Rejuvenation is sanitizing beyond the recommended level.

By signing you agree to each above statement and release LH Spa & Rejuvenation and all of its therapists from any and all liability for the unintentional exposure or harm due to Covid-19.

Full Name

Last Name