Professional Tissue Massage Therapy and Beauty Treatments

Covid-19 pre-treatment declaration form

Please complete the form below at least 24 hours prior to your treatment. If you have any of the Covid-19 symptoms, please seek medical advice.

On arriving for your appointment, you will have your temperature taken by a contactless device and you will be asked to sanitise your hands.

The treatment room is fully deep cleaned between each customer, and it is also cleaned each night by an ultraviolet light system, so you can be assured that you are coming to a safe and clean environment.

*information required

I have no symptoms
Fever/High Temperature (feeling unusually hot to the touch)
New, continuous cough
Loss or change to your sense of smell or taste

If you do have any of these symptoms, please seek medical advice and self-isolate. I will not be able to see you until you have a negative Covid-19 test result or 14 days have passed.

No
Yes
No
Yes

If you have answered yes, treatment can only proceed with GP written approval.

No
Yes
No
Yes

If yes to any of the above treatment cannot take place until a negative test result has been received.

No
Yes

 

I agree that I am providing accurate health information*

By ticking the box 'I agree', you are stating to have answered the questions honestly and to the best of your knowledge for the safety of yourself and others.