Illness Guidelines, Consent and Health Department Reporting

By signing below, I'm confirming that Iunderstand the following:

Illness Guidelines:
1. I understand that if I had a fever in the last 24 hours of 100°F or above, that I should cancel/reschedule my appointment for a later date.

2. I understand that if I have recently had, any respiratory or flu symptoms, sore throat, shortness of breath, or any unexplained skin rash, that I should cancel/reschedule my appointment for a later date.

3. I understand that if I have been in direct contact with anyone in the last 10 days who has been diagnosed with or has coronavirus-type/flu symptoms, that I should cancel/reschedule my appointment for a later date.

4. I understand that upon arrival, I will need to undergo a pre-appointment Screening before receiving treatment, I will sanitize my hands upon arrival and departure.

5. I understand that if I'm at all ill, I should reschedule at my own convenience. 

6. I understand that I'll be asked to mask if I'm presenting with any type of cough or sneeze. 

Consent for Treatment:

I understand that I'm receiving massage therapy at my own risk and that it's not acute or diagnostic care. Close contact, including massage therapy, increases the risk of infection due to proximity. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business from any claims related thereto. I give my consent to receive treatment from this practitioner, Jennifer Sheets, LMT.

Health Department Reporting:

I understand that my name and contact information might be shared with the State Health Department in the event that a client or practitioner tests positive for Covid-19. My contact details will only be shared in the event they are relevant based on suspected exposure date, and only for the appropriate follow-up by the health department.

Minors: Both Client and Guardian must sign waiver. (Only one field provided to sign both signatures.)