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Consent Form
Consent to Treat a Minor
Pregnancy Consent Form
Home
Book your session
Services & Prices
Contact & Locations
A Typical Session
About Reflexology
Forms
Consent Form
Consent to Treat a Minor
Pregnancy Consent Form
Walk in, Float out !
Name
*
First Name
Last Name
Email
*
Have you shown any symptoms in the last 14 days such as a high temperature or continuous cough?
*
Yes
No
Have you been in contact in the last 14 days with someone who has been diagnosed or is suspected of having Covid-19?
*
Yes
No
Do you consent to treatment without you or your therapist wearing full PPE? Therapists will be wearing a face mask/covering and are fully up to date with regulations and client care procedures.
*
Yes
No
Thank you!
