Request edit access
Pre-appointment Questions
Please complete this form within 24 hours of your scheduled appointment at Tranquility Den.
All information will be kept confidential.
Our staff have no symptoms of illness, nor have we been in contact with anyone who has/may have COVID-19.
All work surfaces and high touch areas have been thoroughly cleaned and sanitized.
All linens have been freshly laundered and disinfected.
Our staff wear masks at all times inside the spa.
Your therapist always washes his/her hands and lower arms before your massage.

We have implemented protocols and have taken measures beyond what is required under CDC guidelines to help create a safe environment for you and our staff.

* Certified HEPA filters with UV light in every massage room and waiting area that clean the air
* Hand sanitizer and virus killing wipes are available
* No food or drinks inside the spa, but we'll give you a water bottle to-go
* No chatting during the massage (sorry! it's too difficult for the massage therapist to talk and work with the mask on)
* Instead of our normal warm greeting, we will do a touch-free "Namaste Nod"
* In addition to masks, staff can wear a shield and gloves, if requested.
* Clients are asked to wait in their car or outside until 2-3 minutes before their appointment time.
* Clients must wear masks at all times. The mask should cover your nose and mouth.
* Client's temperature will be taken prior to entering the spa using a no-touch thermometer. If the client’s temperature is above 100, we will ask him/her to reschedule. Please note that the thermometer is very sensitive, so if you sit in a hot car or stand in the sun, it will raise your temperature reading by several degrees.

We appreciate your cooperation!

What is your name?
What is your phone number? *
Have you tested positive for COVID-19 at any point? *
If you answered YES, when did you have COVID-19? Have you been quarantined at least 14 days and CLEARED by a medical professional as NON-CONTAGIOUS? *
If you answered NO, are you waiting for test results from a COVID-19 test?
Clear selection
Have you recently traveled out-of-state in the past 14 days? If yes, which state did you visit? *
Have you been to any social gatherings with more than 6 people in the last 14 days?
Clear selection
Have you been in contact with someone who has either tested positive for COVID-19 or shown symptoms of illness? If YES, how recently were you in contact with this person?
Clear selection
Have you or any other household member experienced any of the following symptoms within the last 14 days? *
Fever or above-normal temperature?
Shortness of breath or other difficulties breathing?
Runny Nose?
Sore Throat?
Any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue?
Recent loss of taste or smell?
A chronic health condition that causes a compromised immune system?
If you answered YES to any of the questions above, please explain:
Please check each box below to confirm that you will comply with our safety protocols as required by the CDC. *
I understand that if the answer to any of the questions is yes, upon review by the owner and your massage therapist, I may be asked to reschedule my appointment. I understand that it is my moral obligation to answer truthfully to the best of my ability, so as to reduce the risk of illness of staff of Tranquility Den or other guests at the spa. If I develop any symptoms of COVID within two weeks after my appointment date, I agree to inform Tranquility Den right away. Please sign by typing your FULL NAME. Thank you for your cooperation! *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy