Covid-19_Health | Best Spa| Concord NC

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Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: Fever, Chills,Sore Throat, Shortness of breath or difficulty breathing, New cough, New loss of taste or smell, New rashes or lesions, Nausea or vomiting and Diarrhea

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

5387 Village Drive NW
Concord, NC 28027
ph:704-448-0206
e: info@itsagardenlife.com

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