My goal is to provide a safe environment for my clients.
Due to the outbreak of COVID-19, I am taking extra precautions with the intake of each client, health history review, as well as sanitization and disinfecting practices.
This document provides information that I ask you to acknowledge and understand regarding the COVID-19 virus.
The COVID-19 virus is a serious and highly contagious disease. A weak or compromised immune system (including, but not limited to, conditions like diabetes, asthma, COPD, or any prior or current disease or medical condition) can put you at a greater risk of contracting COVID-19. Please disclose any condition that compromises your immune system and understand that I may ask you to reconsider treatment at this time.
Symptoms of COVID-19 include:
• Dry cough
• Difficulty breathing
• Nausea or vomiting
• New widespread muscle pain
• Red or purple toes
• Loss of taste & smell
• Bruising, redness, swelling, or cramping in lower legs and feet
I agree to the following:
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 COVID19 within the last 30 days.
I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days.
I fully understand and acknowledge the above information, risks and cautions regarding a compromised immune system.
I understand that this business (Cuyahoga Massage Therapy) and my massage therapist cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client.
By electronically signing below I agree to each above statement and release the massage therapist and business from any and all liability for the unintentional exposure or harm due to COVID-19.