Client Health Disclosure Form

This form must be completed and submitted within 24-hours before your appointment, and is only valid for 24-hours prior. This form will be required before all Sanctuary Day Spas appointments. Please consider the safety of yourself and our staff.

Please answer all questions below

Have you tested positive for COVID-19 or had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?

Have you traveled outside of Canada in the past 14 days?

Do you have any of the following symptoms?

  • Fever
  • New onset of cough
  • Worsening chronic cough
  • Shortness of breath
  • Difficulty breathing
  • Sore throat
  • Difficulty swallowing
  • Decrease or loss of sense of taste or smell
  • Chills
  • Headaches
  • Unexplained fatigue/malaise/muscle aches (myalgias)
  • Nausea/vomiting, diarrhea, abdominal pain
  • Pink eye (conjunctivitis)
  • Runny nose or nasal congestion without other known cause

If you are 70 years of age or older, are you experiencing any of the following symptoms?

  • Delirium
  • Unexplained or increased number of falls
  • Acute functional decline
  • Worsening of chronic conditions

Access to this spa will not be granted to any guest who has either not completed this form, or has been unable to check all of the above criteria.

In order to protect the safety of our staff and our clients, we ask that you must wear a face mask at all times.