Chillout Spa

Covid-19 vaccination declaration and health screen

Please note that Chillout Spa operates using the Covid-19 Vaccination Certification.

Name

Email

Phone number

Have you received 2 doses of the Covid-19 vaccination?

If you have received two Covid-19 vaccinations, what was the date of your second Covid-19 vaccination?

Have you been diagnosed with or suffered from Covid-19?

If yes, what was your recovery date?

Can you confirm the following on the date of your appointment?

You are well upon entering the Chillout Spa and you do not have any respiratory infection symptoms which include any of the following: cough, sore throat, shortness of breath, head-cold symptoms (runny nose, sneezing), loss of sense of smell or a fever or are awaiting a respiratory virus test

If you have been tested for Covid-19 over the last 14 days, you have received confirmation of a negative COVID-19 test within 72 hours and have isolated since getting the test

You have not had close contact with someone with current confirmed or probable COVID-19 or other respiratory infection in the last 14 days

You have not returned from any overseas country within the past 14 days, or work in quarantine, or are self-isolating

You have not had close contact with someone who has the above travel or work history within past 14 days

Covid 19 - I have read, agreed and will adhere to the requirements as outlined on the Covid-19 page of the chilloutspa.co.nz website

Acknowledgement - I acknowledge that the information provided by me in this form is true and correct, and I have not withheld any information that may be relevant to my treatment. I acknowledge that it is my responsibility to inform Chillout Spa of my medical conditions and medication, vaccination status and potential exposure to Covid-19, and to disclose any changes to the above information. I agree Chillout Spa is entitled to rely solely on the information provided in this form. I consent to this treatment and to any other treatments I may have in the future.

Address

Message Sent.

Meadowbank
Auckland 1072
New Zealand

Call or send a message:
021 2626 720

OPEN HOURS

By appointment only

Tuesday - Saturday

Email us here

Covid-19 vaccination declaration and health screen

CHILLOUT SPA

OPEN HOURS

OUR PARTNERS