Aloha Nani Massage

Health and Safety Guidelines

Updated Client consent to treatment Form 5/15/2022
Aloha Nani Massage MAE #3465 


 At Aloha Nani Massage, we take all infectious diseases, viruses, bacteria, allergies, and other health issues very seriously.

If you have allergies to any essential oils, nuts, or body butter, please inform your therapist during the intake process.

Please inform your therapist if you have any surgeries, injuries, medication, or other health concerns that may affect your massage.

Aloha Nani Massage Reserves the Right to refuse service to anyone. 


Health Questionnaire 


IN THE PAST 5 DAYS Have you or anyone in your household experienced ANY flu or cold-like symptoms? Symptoms may include persistent cough, runny nose, sore throat, congestion, fever OVER 100.0, headaches, chills, body aches, lightheadedness, dizziness, vomiting, loss of sense of taste or smell? 

YES_______ NO _______ 

IN THE PAST 14 DAYS Have you had close contact with anyone who has tested positive for Covid 19? 

Close contact through proximity and duration of exposure: Someone who was less than 6 feet away from an infected person (laboratory-confirmed or a clinical diagnosis) for a cumulative total of 15 minutes or more over 24 hours (for example, three individual 5-minute exposures for a total of 15 minutes). 



For Anyone Who Has Been Around a Person with COVID-19

Anyone who has had close contact with someone with COVID-19 should quarantine for 14 days after their last exposure to that person. Or get tested after five days. 


Have you tested positive for Covid 19 in the past 14 days? 



 I think or know I had COVID-19, and I had symptoms

You can be around others after:

  • Ten days since symptoms first appeared and

  • 24 hours with no fever without the use of fever-reducing medications and

  • Other symptoms of COVID-19 are improving*

*Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation​

These recommendations do not apply to people with severe COVID-19 or with weakened immune systems (immunocompromised).



• If you have answered YES to any of these questions, DO NOT book or come in for your appointment.

 If you become ill before your appointment, we will reschedule you.

Please send us an e-mail to or text (808) 896-9343 to reschedule.

 You may cancel your appointment online 30 minutes before your scheduled appointment- otherwise, A $35 no-call / no-show fee will apply.

 • I understand that because the services provided by Aloha Nani will involve physical touch and close physical proximity over an extended period, there may be an elevated risk of disease transmission. I acknowledge that I am aware of the risks involved and consent to receive treatments provided by Aloha Nani Massage and will not hold Aloha Nani Massage or any practitioner liable for any transmission of ANY disease.

I have also been made aware that the physical space of Aloha Nani Massage has been sanitized between each client as per industry standards antiseptic and bactericidal solutions regulated by the EPA.

Aloha Nani Massage has provided Hand Sanitation Stations, Tissues and Requires hand washing of staff and clients for at least 20 seconds before entering treatment rooms. The State requires facial coverings of Hawaii. 

I will arrive on time and no more than 5 minutes before my scheduled appointment time to observe social distancing and privacy of other clients. 

I may help myself to the restroom key and have a seat on the bench outside of Aloha Nani Massage until my therapist comes to greet me.

My therapist will invite me in when the waiting area is clear of other clients and sanitized.   

My therapist will check my temperature. If my temperature is 100 or over, two more attempts will be made before I will have to reschedule 

While inside Aloha Nani massage, I agree to follow social distancing guidelines of 2 meters during check-in. I will also pursue other health and safety recommendations such as hand sanitizing, avoiding touching things, no unnecessary physical contact, coughing into your elbow, and no excessive talking when on the treatment table.

By acknowledgment below, you agree to the contents of this form. You can truthfully answer NO to all the questions at the time of booking your appointment, and before arriving at your appointment, give Aloha Nani Massage consent to perform therapeutic bodywork and or massage therapy to improve my health and wellness.