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2022 - COVID-19 pre-session safety checklist
Required prior to receiving any bodywork. Thanks for your understanding!
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* Indicates required question
Email address
*
Your answer
Name (first and last)
*
Your answer
Have you been diagnosed with COVID-19 at all?
*
Yes
No
Maybe
Other
Have you had a cough, fever, sore throat, “tickly” throat, nausea, shortness of breath, headache, loss of smell, taste in the last 2 weeks?
*
Yes
No
Maybe
Other:
Has anyone in your germ pool been diagnosed with COVID-19? (GERM POOL is anyone you are in contact with WITHOUT a mask.)
*
Yes
No
Maybe
Other:
Have you been exposed to anyone who thinks that they might have COVID-19 in the last 2 weeks? (Inside or outside of your germ pool.)
*
Yes
No
Maybe
Other:
Are YOU ALWAYS wearing a mask when in contact with ANYONE outside of your germ pool? This includes grocery stores, places of worship, friend's houses, workplaces, and ALL PUBLIC SPACES.
*
Yes
No
Maybe
Other:
Are ALL OTHER PEOPLE IN YOUR GERM POOL always wearing a mask when in contact with ANYONE outside of your germ pool? This includes grocery stores, places of worship, friend's houses, workplaces, and ALL PUBLIC SPACES.
*
Yes
No
Maybe
Other:
Are you high risk? That means that you are over age 60 or possess health issues that increase your risk (immune system issues, active cancer and/or chemotherapy, heart issues, lung issues, etc.).
*
Yes
No
Maybe
Other:
Are you vaccinated?
*
FULLY - shots and past the waiting period
Completed shots, but NOT past the waiting period
One shot (for those that require 2)
Not vaccinated yet
Don't plan to vaccinate
Other:
Required
Anything to add or ask?
Your answer
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