Intake Form for Bodywork
For increased health and safety, please fill this out 24 hours prior to each massage (until further notice). Be sure that the information you'll give is accurate and complete. Please get medical attention if you have any COVID-19 signs. Thank you for taking the time to support a safe environment for all!
In the past 14 days, I have experienced...
Fever 101°F +
Unexplained body aches or pain
Shortness of breath
Chills with or without body aches
Recent loss of sense of smell or taste
Unexplained sores on soles of feet
Non-allergy related runny nose
Should be Empty:
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