Today's Date (required)
Your Name (required)
Your Email (required)
Have you had a fever or any symptoms related to COVID-19 in the last 14 days? (required) ---NoYes
Have you been around anyone exhibiting symptoms of COVID-19 in the last 14 days? (required) ---NoYes
Are you living with anyone who is quarantined due to COVID-19? (required) ---NoYes
Do you understand that by entering this establishment you are assuming all responsibility concerning your health and Emmary Day Spa and its employees can not be held liable for any exposure to Covid-19 due to mis/unknowing information given by clientele? (required) ---NoYes
By typing your name in the "Client Signature" space, you certify that all the information and answers to questions herein are complete, true and correct to the best of your knowledge. Client Signature
