COVID-19 Pre-screening

My number one priority is to protect all of my clients from the coronavirus. If you have been exposed to the coronavirus you may spread the it to myself and/or other clients. Therefore, prior to every appointment, I will be asking you to honestly answer the following questions to help reduce the chances of transmission:

Name*
First Last
Email*
Hidden
Phone*
Hidden
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Hidden
Who referred you? How did you hear about me?*
Covid-19 Prescreening
1. Have you been FULLY vaccinated for COVID-19?*
- Yes
- No
If yes, please text me a copy of your vaccine card or bring it to your appointment. Without proof of vaccination you will need to wear a mask during your massage.
2. As with any communicable disease like a cold or flu, you may be exposed to the coronavirus at any time or in any place. While I am taking the safety of my clients extremely serious, by practicing social distancing and mask wearing guidelines set by the CDC and by employing new safety and sanitation protocols, I am not an expert in the risk analysis of COVID-19 and I cannot guarantee that any of these measures will completely protect you from contracting COVID-19. Do you assume all risks and chose to receive your massage treatment today?*
- Yes
- No
3. Do you agree to notify me immediately test positive for coronavirus or are diagnosed with COVID-19?*
- Yes
- No
Date*
MM slash DD slash YYYY
CAPTCHA

Covid-19 Prescreening

JAMES DUSTIN MASSAGE

Follow Me