Your Safest Massage New Client ApplicationHere’s how I am keeping my clients safe. COVID Protocols Name * Email * Phone * (###) ### #### What are your top three wellness goals? * How can I help you achieve those goals? * How did you hear about my practice? * COVID Symptom Safety * Have you experienced any of the following symptoms in the last 14 days? Fever (temperature over 100.0 degrees) Cough Difficulty breahting Shortness of breath Chills, or muscle or body aches Runny nose or nasal congestion New loss of taste or smell; headache Nausea, vomiting or diarrhea NO, NONE OF THE ABOVE COVID Travel Safety * In accordance with the MA Travel Order, please verify that you have not travelled outside the reduced-risk area as identified by MA, or have received a negative test result in the past 72 hours. In the last 14 days, I have not travelled out of the Northeast area (MA, NH, VT, ME, NY, NJ, CT) I have received a negative test result in the past 72 hours. Thank you! I’ll be in touch shortly to discuss your goals and scheduling your first session!
