Knot So Nice Massage Therapy
COVID-19 Recent Health Form. Please fill this form out before requesting a massage appointment. I ask that you answer these questions truthfully so that this health and wellness work can continue to be practiced. Be sure that the information you'll give is accurate and complete. Please get immediate medical attention if you have any of the severe COVID-19 signs.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
In the past 14 days, I have experienced...
Yes
No
Fever 101°F +
Unexplained body aches or pain
Coughing
Sore throat
Shortness of breath
Chills with or without body aches
Recent loss of sense of smell or taste
Unexplained sores on soles of feet
Unusual fatigue
Non-allergy related runny nose
Signature
Submit
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