Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please read the following and acknowledge below.
Symptoms of COVID-19 include:
- Shortness of breath
- Difficulty breathing
- Repeated shaking with chills
- New loss of taste or smell
- Muscle pain
- Sore throat
I understand the above symptoms and affirm that I, as well as all household members do not currently have, nor have experienced the symptoms listed above within the last 14 days.
I affirm that I, as well as all household members:
have not been diagnosed with COVID-19 within the last 30 days
have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days
have not traveled outside of the country or to any city outside of our area that is or has been considered a "hot spot" for COVID-19 infections within the last 30 days
I understand that, because massage therapy work involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19.
By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business from any claims related thereto. I give my consent to receive treatment from this practitioner.
I additionally affirm that ALL OF THE ABOVE will be true for each appointment going forward.