top of page
Logo small

Client Health Declaration
This form must be completed and submitted at least 7 days before the booking.

Have you had any operations, illness, injuries over the last 12 months?
Do you suffer from any allergies?
Are you currently taking any prescribed medicine?
Are you currently receiving treatment from a GP/health professional?
Do you currently have any of the following conditions:

Consent for receiving a treatment/s with a practitioner from Love Pamper Company. 

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 love pamper company practitioner assigned to my booking.

I release the practitioner from any negligent misrepresentation that may be contained in this form. I give permission for Love pamper company 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 give my consent to receive treatment from the therapist assigned to my booking by Love Pamper Company.

Thank you for completing!

bottom of page