COVID Waiver Form | The Spa Terme Di Aroma

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COVID Waiver Form

ENSURING YOUR HEALTH & SAFETY

Before receiving your treatment at The Spa Terme di Aroma, you are required by Pennsylvania law to complete a COVID-19 release form. You can complete this form at the time of your treatment or by completing the form below before arriving at the Spa.

First Name*
Last Name*
Email
Have you had a fever in the last 24 hours of 100°F or above?*
- Yes
- No
Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath?*
- Yes
- No
Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms?*
- Yes
- No
Consent for Treatment:*
I understand that, because massage therapy and/or skin care work involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless The Spa Terme Di Aroma from any claims related thereto. I give my consent to receive treatment from The Spa Terme Di Aroma and its practitioners.
I agree to the treatment terms and conditions.
Date*
Date Format: MM slash DD slash YYYY