Health History Review and Consent Form
Due to COVID-19 we are taking extra precautions to protect your health and the health of our staff members with an intake for each client that includes an updated health history review. This intake will be performed each time you visit Firefly Wellness Day Spa, until further notice.
We require that you take your temperature at home before EACH VISIT to Firefly. If your temperature is 100.4 or higher please reschedule your appointment. Please initial: By signing below I agree to each above statement and declare that the information provided is true and accurate to the best of my knowledge. I acknowledge and understand the risk of being exposed to COVID-19, and voluntarily agree to assume all risks involved when visiting Firefly Wellness Day Spa, releasing the business and its employees from any and all liability for the unintentional exposure or harm due to COVID-19.
This business and all employees of this facility agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions. ~ The Firefly Wellness Day Spa Team ~
* By signing, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By signing here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.
March 6, 2021