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 +

    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

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