Health Declaration

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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, cough, sore throat

I have not been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I have provided is accurate and complete

Thanks for submitting!

Hridayam, LLC

(786) 473-4175

3850 Bird Road, suite 502

Miami, FL 33146

ABOUT
SHOP
COACHING
- CONSULT
- RESOURCES
MASSAGE
EVENTS
BLOG
CONTACT

The statements made on this website have not been evaluated by the Food & Drug Administration. Services and products provided by Hridayam LLC are not intended to diagnose, cure, or prevent any disease. If a condition persists, please contact your physician or health care provider. The information provided on this website or during your sessions is not a substitute for a consultation with your doctor, and should not be considered medical advice.

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