For all of our 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 immediate medical attention if you have any of the severe COVID-19 signs.
Name *
Email *
Phone Number *
In the past 14 days, I have experienced...
Fever 101°F/38°C +
YesNo
Unexplained body aches or pain
Coughing
Sore throat
Shortness of breath
Recent loss of sense of smell or taste
Chills with or without body aches
Unexplained sores on soles of feet
Unusual fatigue
Non-allergy related runny nose
I agree that I am providing accurate health information.
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