Returning Client Update and Liability Waiver
Please use this to update any information that may have changed within the past year and/or past couple of months. Please also make sure you have medical clearance to receive bodywork and massage services.
Were there any changes to your personal contact information recently? If yes, correct below. *
Were there any changes to your health and/or medical status recently? If yes, please describe below. *
Have you had a fever in the last 24 hours of 100°F or above? *
Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, fatigue, headache/migraines, or shortness of breath? *
Do you now, or have you recently had, any chills, muscle aches, new loss of taste/smell, or new rashes/lesions? *
Have you been in contact with anyone in the last 14 days who has been diagnosed with Covid-19 or has coronavirus-type symptoms? *
Do you have any special requests I should prepare for? *
Do you have any questions or concerns? *
Please review the updated client terms.
Please review the updated liability waiver.
Client Electronic Signature *
Date *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy