• Due to the Coronavirus (COVID-19),    Body by Gems is taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete and sign the following document.

Symptoms of COVID-19 include but are not limited to:

• Fever

• Fatigue

• Dry Cough

• Difficulty Breathing

• Loss of Smell or Taste 

 

 

Agree to the following:

☐ I understand and affirm that I, nor any members of my household do NOT currently have or have experienced any of the following symptoms within the last 14 days.

 

☐ I affirm that I, as well as ALL members of my household have not been diagnosed with COVID-19 within the last 30 days.

 

☐ I affirm that I, as well as ALL members of my household have not knowingly been in contact with anyone who has been diagnosed with COVID-19 within the last 30 days.

 

☐ I affirm that I, as well as ALL members of my household have not traveled outside of the country and have not traveled to any city that may be considered a "hotspot" for COVID-19 infections within the last 30 days.

☐I understand that this business and my manual lymphatic drainage nurse cannot be held liable for any exposure to the virus, or any other contagion caused by misinformation on this form and the health history form provided by each client.