Health and Safety guidelines
Updated Client consent to treatment Form 2/12/2021
Aloha Nani Massage mae #3465
PLEASE READ & ACKNOWLEDGE THE FOLLOWING:
SPREAD ALOHA NOT GERMS
Aloha Nani Massage Reserves the Right to refuse service to anyone. Please make sure you can answer no to the following questions.
* Have you or anyone in your household traveled in the past 10 days? Yes__ No__
* Have you had a fever in the last 24 hours of 100°F or above? Yes__ No__
*Have you received the vaccine in the past 7 days? yes___ no____
*Have you recently had any respiratory or flu symptoms, fever, sore throat, or shortness of breath, loss of taste or smell? 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__
*Is anyone in your home ill with flu or Covid Like symptoms? Yes__ No__
• 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 email@example.com or call/text (808) 896-9343 to reschedule. You may cancel your appointment online 30 mins prior to your scheduled appointment- otherwise, A $35 no-call / no-show fee will apply.
Please wait 10 days after traveling or 7 days after any flu-like symptoms have subsided before arriving at Aloha Nani massage.
• I understand that because the services provided by Aloha Nani will involve physical touch and/or close physical proximity over an extended period of time, there may be an elevated risk of disease transmission. I acknowledge that I am aware of the risks involved and give consent to receive treatments provided by Aloha Nani Massage and will not hold Aloha Nani Massage or any practitioner within liable for any transmission of ANY disease. I have also been made aware of the physical space of Aloha Nani Massage has been sanitized between each client as per industry standards germicide, 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 prior to entering treatment rooms. Facial coverings are required by the State of Hawaii. We ask that all clients follow this recommendation unless a medical condition exempts the client from wearing one.
I will arrive on time and no more than 5 mins early to observe social distancing. I may help my self 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 has been sanitized. My temperature will be checked. While inside Aloha Nani massage I agree to follow social distancing guidelines of 2 meters during check-in. I will also follow other health and safety recommendations such as hand sanitizing, avoid touching things, no unnecessary physical contact, coughing into the elbow, and no unnecessary talking when on the treatment table.
By acknowledgment below, you agree to the contents of this form and are able to truthful answer NO to all the questions at the time of booking your appointment, and before arriving at your appointment, giving Aloha Nani Masasge consent to perform therapeutic bodywork and or massage therapy to improve your health and wellness.