Forms | Ellen Johnson, Licensed Electrologist

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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 or any symptoms of Covid-19

I haven’t been in close contact with a Covid-19 patient in the last 14 days or been diagnosed with Covid-19 in the past 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Phone

Thanks for submitting!

Hours:

Every other Monday 11:15am-3:00pm

Wednesdays 10:30am-3:00pm

Thursdays 12pm-7:00pm

Fridays 10:30am-3:00pm

Rates (August 2026-):

Consultation and 15-minute session- $70

(For all new clients)

15-minute session- $65

30-minute session- $85

45-minute session- $110

1 hour- $135

**CASH, VENMO, OR CHECK ONLY**

260 Gateway Dr. Suite 6A, Bel Air, MD 21014

Location in Inner Courtyard

443-203-9595

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