Covid19/Vaccine Waiver Consent

Form must be read & consented to before visiting or booking

COVID -19 VACCINE RECEPIENTS.

PLEASE WAIT 4 DAYS TO BOOK A SERVICE AT EVERYBODY MASSAGE. IF YOU ARE HAVING ANY SYMPTOMS OF THE SHOT PLEASE DO NOT BOOK AN APPOINTMENT OR COME IN.

PLEASE CALL US ASAP TO BE CANCEL APPOINTMENT IF YOU ARE HAVING ANY SYMPTOMS OF THE SHOT.

THANK YOU FOR YOUR UNDERSTANDING.

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 STILL IN EFFECT AS OF 3/06/2021

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 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 our 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 10 days? IF so please reschedule for 10 days out. *

- I AGREE


I confirm that I AM NOT presenting any of the following symptoms of COVOID-19 listed below: * • Temperature above 99 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 10 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 10 days out.

- I AGREE

I agree that I HAVE NOT traveled outside the United States in the past 5 days. If so please call immediately cancel or reschedule for 5 days out.

- 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 2020 at 12am to Wednesday, Sep. 1st, 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.