The Hart Spa Covid-19 Form
Please complete the form below so we can best protect you, our clients and our staff.
Full Name: *
Contact Number: *
Email: *
Are you experiencing a cough? *
Are you experiencing shortness of breath? *
Have you had a fever (above 37.7c Degrees) in the last 14 days? *
Have you noticed a loss of change in your sense of taste or smell? *
Have you had any contact with anyone that has suspected COVID-10 in the last 14 days? *
I have understood, read and completed this form truthfully to my knowledge. *
Required
I knowingly and willingly consent to having services at during the COVID-19 pandemic. *
Required
I consent for the services to be carried out which involves a staff member of The Hart Spa team being in physical contact with me with less than 2 metres distance. *
Required
I confirm to my knowledge that I, my household or social bubble have not been on contact with anyone that has had symptoms of COVID-19 in the last 14 days. *
Required
To prevent the spread of the virus and protect each other, I confirm that I will strictly follow guidelines. *
Required
If guidelines are not strictly followed, I understand that The Hart Spa has the right to cancel the appointment with the full cost of the service being charged and any other paid costs being non-refundable. *
Required
I confirm that I release The Hart Spa staff member performing the service and The Hart Spa as a business from any and all liability for the unintentional exposure or harm due to COVID-19. *
Required
Digitally Sign Below: *
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