Health Waiver | KhooMassageTherapies

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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 the symptoms: fever, cough, sore throat, cold

I do not have any allergies that I know of.

Initials

Date

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

Thanks for submitting!

I haven’t been in close contact with a Covid-19 patient in the last 14 days

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

Please let us know any conditions we should be aware of such as pregnancy, injuries etc.