Coronavirus Consent Form

Please review before making your appointment:

If you have been diagnosed with Coronavirus disease (COVID-19) and are taking blood thinners or have skin lesions, please reschedule your appointment for when you have written medical clearance from your physician to have massage therapy.

If you answer yes to any of the questions below, we will postpone your appointment without penalty and reschedule you.

  1. Have you had a fever in the last 24 hours of 100°F or above?
  2. Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath?
  3. Do you now, or have you recently had, any chills, muscle aches, new loss of taste or smell, or new rashes or lesions?
  4. Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms?
  5. Have you been traveling or out of the country in the last two weeks?

If you have answered no to the above questions, have not been diagnosed with Coronavirus disease (COVID-19), or have been diagnosed with Coronavirus disease and are no longer contagious and have a doctor’s note of approval for massage therapy or you have been fully vaccinated and have waited two weeks for your antibodies to build to full strength, you are free to come in:

  1. Please be on time by arriving early and kindly wait outside until the time of your appointment.
  2. Please wear a mask during your appointment. Masks will be worn by both the practitioner and client at all times. We will make sure you are as comfortable as possible.
  3. We recommend that you wash your hands and face or shower before and after your appointment.
  4. When you come in for treatment, we assume you have read and agreed to the Consent for Treatment paragraph below:

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. 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.

_______________________________________________(Printed name)