COVID-19 Health Checklist

Welcome to Kanani Pearl Spa!

To ensure the health and safety of our staff and clients, please fill out this form prior to your visit. All information will be kept 100% private and confidential.

First name

Last name

Date of birth

Have you been traveling or been in large public gatherings in the past 14 days?

Yes

Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?

Yes

Have you experienced any cold or flu-like symptoms in the last 14 days (fever, cough, shortness of breath or other respiratory problem)?

Yes

Thank you!

Your COVID-19 form has been sent. We look forward to seeing you soon!

There was an error!

We were unable to process your COVID-19 form. We apologize for the inconvenience. Please try again, or conact us at (503) 242-5500 or info@kananipearl.com