Covid Safety - Health & Consent Form

(Fillable Form Below)

Close-contact sessions are not without risk at this time, but the safety of all my clients is my top priority. I am committed to providing an environment and sessions that meet the highest sanitation and hygiene standards. We have implemented changes at both locations to make the environment and your session as safe as possible. To get the most from your sessions, I ask that clients be aware of the following standards and requests to help ensure your safety, the safety of other clients, as well as other therapists that share the spaces.


  1. Meeting or exceeding all state, local and regulatory guidelines relating to sanitation and hygiene.

  2. Following Covid-19 sanitation and hygiene standards, including face masks and eye protection.

  3. Operating at reduced capacity, and leaving extended times between sessions for venting, cleaning and sanitizing.

  4. Providing continuous HEPA air filters.

  5. As always, providing clean linens for each session.

  6. Washing or sanitizing my hands for a minimum of 20 seconds at the start and end of a session.


  1. Rescheduling your appt immediately, if you or a household member experience any of the symptoms associated with Covid-19; are exposed to anyone who might have Co-19; or have worked, traveled, or otherwise in environments or at events in the 14 days before your appt, where there was an increased risk of exposure. 

  2. Respecting our sanitation and hygiene standards and processes posted here, and at my locations

  3. Washing or sanitizing hands for a minimum of 20 seconds prior to beginning of your session, and washing or using hand sanitizer as needed or requested.

  4. Wear face coverings from entry to exit, & permit a contactless temperature check.

  5. Sharing special sanitation or hygiene concerns or requests prior to arriving at the clinic.

  6. Complete Affirmation/Waiver below prior to your next appointment (just once).

  7. Inform me or the health department immediately if you develop Covid-19 symptoms within 14 days after your appointment, so that I an able to take necessary precautions.

  8. UPDATE me if you ever have Covid-19. Some long-term symptoms of Covid-19 (incl. vascular, stroke, skin issues, etc) carry precautions for certain bodywork techniques.

Please fill out Before your first appointment