Client Disclosure Form
To best protect your health and the health of others, please fill out this form
before each massage and bodywork session. Thank you!
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Have you been tested for COVID-19? If yes, what type of test did you have?
Have you been in places with a high infection rate within the last two weeks?
For example, state designated “hot spots” or the BLM protests?
Please check if you are experiencing any of the following as a NEW PATTERN since the beginning of the pandemic:
Diarrhea, digestive upset
Nasal, sinus congestion
Loss of sense of taste or smell
Shortness of breath
Sudden onset of muscle soreness (not related to a specific activity)
Rash or skin lesions (especially on the feet)
I have not experienced any symptoms
Do you have any new discomfort with exertion or exercise?
I declare that the information provided above is true and accurate to the best of my knowledge.
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