COVID-19 HEALTH FORM | Sundara Spa

Covid-19 Health Questionaire

First Name

Last Name

I confirm that I am not experiencing or have been in close contact with anyone experiencing the following symptoms: Fever, Chills, Cough, Runny nose, Difficulty breathing, Loss of smell or taste.

I confirm that I have not tested positive to a coid-19 test (Rapid or PCR) or have been in close contact with someone who has tested positive. I also confirm that I am not currently waiting on covid-19 test results (Rapid or PCR) or have been in close contact with someone waiting on results. (If youve tested positive or are waiting on results please contact Sundara Spa at 705-543-9753 to make us aware of this and to cancel any booked appointments).

I confirm that I have not shown symptoms of Covid-19, or been in close contact with a Covid-19 patient, or anyone showing symptoms of Covid-19 in the last 14 days

I confirm that I have answered all questions truthfully and will follow all health/safety protocols set by Sundara Spa to ensure my health/safety and that of other guests/employees. I also confirm that I will pay the full service fee for any appointments cancelled due to failing to adhere to these guidlines or by providing fale information.

Initials

Date

I declare that the information I have provided is accurate & complete

Thank you for submitting!