Covid-19 Screening and Liability Waiver

Have you read my updated office policies and protocol document?
Have you had a fever in the last 24 hours of 100°F or above? Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath?
Have you traveled by plane or attended any large gatherings in the past 14 days?
Do you now, or have you recently had, any chills, muscle aches, new loss of taste or smell, vascular irregularities, unexplained bruising, or new rashes or lesions?
Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms? Have you ever been diagnosed with Covid-19?

Consent for Treatment: 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 understand that if I'm feeling ill in any way I must cancel my appointment. I give my consent to receive treatment from this practitioner.

Office Use Only:

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