If you have ticked any of these boxes after reading this list, you are classed as extremely vulnerable and the government advise that you exercise ‘shielding’.
If you tick any boxes after reading this list, you are at moderate risk from coronavirus and it is very important you follow the advice on social distancing.
Consent for receiving a treatment/s with a practitioner from Glo Pamper Ltd.
By completing this form, I confirm that I am the person named in this form, and have completed the form as fully and accurately as I can. I believe the details to be correct and consent to having treatment with the glo practitioner assigned to my booking. I release the practitioner from any negligent misrepresentation that may be contained in this form. I give permission for glo pamper ltd to share this information with the therapist allocated to my booking only and understand that otherwise this information will be treated confidentially and not shared with anyone else.
I declare that the information I have provided is correct to the best of my knowledge and I understand that, because my treatment may involve touch and close physical proximity over a period of time, there may be an elevated risk of disease transmission, including Covid-19.
I consent to the Glo therapist retaining the details provided on this form for a period of 7 years from today. I further understand that if I am under 18 years of age*, these records will be kept until I reach the age of 25 (7 years after reaching 18).
I give my consent to receive treatment from the therapist assigned to my booking by Glo Pamper Ltd.