Covid-19 Updates 

Name *

First Name

Last Name

Phone *

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I affirm that I, as well as those in my household, have not been diagnosed with COVID-19 within the last 14 days.

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I affirm that I, as well as those in my household, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 14 days.

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I agree to reschedule if I have cared for someone diagnosed with COVID-19 within the 14 days of the appointment.

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I agree to reschedule if I experience any cold or flu-like symptoms within 14 days of my appointment.

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I agree to wear a mask at the time of your appointment

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I agree that I am providing accurate health information.

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I understand that close contact with people increases the risk of infection from COVID-19. By signing this form, I acknowledge that I am aware of the risks involved and give consent to receive massage from Lauren C. Jenkins, RMT.