Health Waiver | KhooMassageTherapies

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Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C.

I am not experiencing any Covid-19 symptoms: fever, cough, sore throat, cold, lost of taste/smell.

I have not been in close contact with a Covid-19 patient in the last 14 days.

I have had at least 2 doses of the Covid-19 vaccine.

I am not experiencing any other discomfort: difficulty breathing, shortness of breath, palpitations, constipation, diarrhoea, nausea, problems/burning sensation/changing in frequency when passing urine, chills/headaches, painful swallowing, fatigue/exhaustion.

I don't have any major illness such as cancer, diabetes, heart/lung disease etc.

I do not have any allergies that I know of.

I am not taking any blood clotting medication.

Please let us know and elaborate on any conditions we should be aware of such as pregnancy, injuries, major accidents/operations etc.

Tell us more. Tailor your session. Tell us where to focus. areas of tension, areas to avoid and the intensity of pressure you prefer.

Please do not tick if you have NOT booked a CBD oil massage. If you have booked a CBD massage, please ensure you tick all the boxes below:

I have booked a CBD oil massage and I confirm the below are true.

I am not on any medication / I have obtained GP verbal/written approval).

I'm not suffering from chronic pain / I have obtained GP verbal/written approval).

I don't have arthritis / I have obtained GP verbal/written approval).

I'm not pregnant or breastfeeding.

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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