MEET YOUR TEAM
COVID-19 INTAKE FORM
First and Last Name
Please list any new medications, injuries, surgeries, or pertinent health information your massage therapist should be aware of:
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Current areas of tension, pain, stiffness, disfunction, etc and any changes since last massage to areas treated:
Have you had a positive COVID-19 test in the past 14 days?
If yes, have you had a negative test/tested out of quarantine?
Have you had close contact with any confirmed or suspected person with COVID-19 in the past week?
Have you travelled internationally?
If yes, have you completed your quarantine or tested out of quarantine?