Additional Intake Form - COVID-19 Questionnaire

Due to the infectious nature of COVID-19, this additional intake form must be completed before EACH massage therapy session.

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Please know that people with COVID-19 can be asymptomatic or pre-symptomatic and still be contagious.  There  is no way to completely protect ourselves from this virus.  

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Ask for the checklist of precautions to see how I am disinfecting my office between sessions.

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Please answer all questions truthfully and follow all directives, so we can do our best to protect each other.

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THANK YOU!