Circle any specific areas you would like the massage therapist to concentrate on during the session:
I name agree that I am accepting a massage from a Licensed Massage Therapist and have disclosed any health-related information to the massage therapist for an effective treatment session. I waive any and all liability regarding the massage to the massage therapist. I understand that massage services are provided for the mind and body and do not replace indicated doctor's care.
Please Note: G3M Massage Therapy and Wellness Center sanitizes all areas and equipment thoroughly prior to and between services for the client’s safety and prevention.
I name , knowingly and willingly consent to have massage therapy services performed by a service provider at G3M Therapy and Wellness Center during the COVID-19 pandemic.I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not, given the current limits in virus testing.I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of massage therapy services, that I have an elevated risk of contracting the virus simply by being in the center.
I confirm that I am not presenting any of the following symptoms of COVID-19 included but not limited to the following list.
To prevent the spread of the contagious virus and to help protect each other, I understand that I will have to follow the centers strict guidelines:
I understand that I will receive a temperature check upon entering the center and must wear a mask over my mouth and nose in order to be serviced by a provider at G3M Therapy and Wellness Center.
I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus.
I understand that the CDC, OSHA, and Maryland Board of Massage Therapy Examiners recommend social distancing of at least 6 feet.
I verify that I have or have not (circle one) traveled outside the United States in the past 14 days to countries that have been affected by COVID-19.
I verify that I have or have not (circle one) traveled domestically within the United States by commercial airlines, bus, or train within the past 14 days. If you have please list:
I understand that G3M Therapy and Wellness Center will not be held liable if I become ill or infected with COVID-19 after being serviced by a service provider.