Covid-19 Client Waiver - Body Wisdom Healing Group

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Covid-19 Liability Waiver

For all of our safety, please fill out this form prior to EACH massage appointment (until further notice). Be sure that the information given is accurate. Thank you!

Covid-19 Waiver

Is your appointment today? *

(If no, please do not fill out this form now - fill it out on the day of your appointment)

Name *

First

Last

Please enter your preferred contact information appointment updates.

Phone

Have you or anyone in your household traveled to or had contact with anyone who has traveled to an area know to be a Covid-19 hot spot within the last 14 days? *

Have you had close contact with persons who may have been exposed to COVID-19 in the past 14 days? *

Are you currently experiencing an of the known Covid-19 symptoms: abnormal fatigue, dry cough, loss of taste/smell, sore throat, difficulty breathing? *

Have you had a fever in the last 48 hours of 100 degrees or above? *

If you answered yes to any of the above questions, you will be asked to reschedule your appointment a week out. No cancellation fee will be applied in this case. Thank you for understanding.

I understand that because massage therapy work involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19.

I understand

I understand that Body Wisdom Healing Group and my Licensed Massage Therapist today cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client.

I understand

I understand that I must keep my mask ON during the entire massage today. No exceptions. *

I understand

Name

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Phone: 614-784-9473
email: info@bwhg.net
2999 Indianola Avenue
Columbus, OH 43202

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