Covid Waiver Consent Form

About your health and risk pertaining to covid-19

We appreciate you.

Our therapist are here to help you feel better in these tough times. We are doing our best to ensure safety for you and your family. With out our staff we would not be able to help you feel your best. Lets work together and we shall get through this together. Thank you for your understanding of our procedures. Please read, agree and submit before your appointment.
Printable MASSAGE INTAKE Form

THIS IS NOT THE COVID FORM JUST THE MASSAGE INTAKE FORM.

COVID INTAKE WAIVER FORM

Please take a moment to read, agree and submit this form. By submitting the form below you agree to knowingly and willingly consenting to having skin/body service during the COVID-19 pandemic and you adhere to our procedures of accepting appointments.


I hold the best interest of EBM and Staff and I do not wish to put anyone in harm by falsely agreeing to the questions below

- I Agree


I understand that EBM reserves the right to refuse service if this form is not submitted or if I have not agreed to all the questions.

- I AGREE


I agree to getting my temperature checked when entering EBM studio and I agree to wearing a mask inside the studio and possible wearing the mask face up during the massage . I also agree to pay $2 for a mask if I do not have one.

- I AGREE


I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not, given the current limits in virus testing.

- I AGREE


I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of massage and facial services, that I have an elevated risk of contracting the virus simply by being at EBM.


- I AGREE


To prevent the spread of contagious viruses and to help protect each other, I understand that I will have to follow the salon’s strict guidelines and cancel my appointment if I do not agree.

- I AGREE


I AM NOT currently experiencing any of the known COVID19 symptoms: abnormal fatigue, diarrhea , loss of smell/taste, dry cough, difficulty breathing or a sore throat? If so please call immediately cancel or reschedule

- I AGREE

My household members have not been in close contact (within 6ft.) of someone who has had a confirmed case of COVID19 in the past 14 days? IF so please reschedule for 14 days out. *

- I AGREE


I confirm that I AM NOT presenting any of the following symptoms of COVOID-19 listed below: * • Temperature above 98.7 degrees • Shortness of breath • Loss of sense of taste or smell • Dry cough • Sore Throat *


- I AGREE

I confirm that I HAVE NOT BEEN around anyone with these symptoms in the past 14 days. *

- I AGREE


I Agree I DO NOT LIVE with anyone who is sick or quarantined. If so please call immediately cancel or reschedule for 14 days out.

- I AGREE

I agree that I HAVE NOT traveled outside the United States in the past 14 days. If so please call immediately cancel or reschedule for 14 days out.

- I AGREE

I agree that I HAVE NOT traveled within Texas or the United States by commercial airline, bus, or train within the past 14 days. If so please book 14 days after travel.

- I AGREE


I agree if am a health care worker, first responder or work in an hospital, I should contact us Immediately before coming in to EBM studio.


-I AGREE


By typing your name and submitting, this serves as a Digital Signature and verifies that you fully agree to our consent/waiver and safety policy for our services. This digital signature holds the same authority as a handwritten one. Thank you.

COVID WAIVER IN EFFECT

Wednesday, July 8th, 12am to Thursday, Dec. 31st, 12am

2001 Ridge Road

Rockwall, TX

Please fill in tabs below to agree to all the questions of relating to Covid-19. We appreciate you understanding as we navigate through this together.

RSVPs are enabled for this event.