Massage Therapy Clinical Intake
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Clinical Information
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Cancer
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Mental Health
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Allergies (including nut and essential oils)
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High/Low Blood Pressure
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Currently taking Warfarin or blood thinning medication
Other
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Neck
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Back
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COVID-19 Questionnaire (Check Appropriate Boxes to Comment Below)
I currently do not have any COVID symptoms including:
A new cough
Loss of smell or taste
Temperature of 37.8 degrees or more
I agree to wash/sanitise my hand and have my temperature taken before treatment
I have not been told to self isolate or come into direct contact with someone who has tested positive for COVID
I agree to postpone or cancel my appointment if I have any COVID symptoms or have been told to self isolate
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Review & Agree
Consent to treatment
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