Pre-massage agreement and COVID-19 questionnaire
Mahalo for agreeing to keep our community safe while getting your massage.
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Name, Oahu address, and phone number *
Residency *
(For visitors to Oahu) Home address and approximate date of departure
I will wear my mask for the duration of my visit and massage session. MASKS ARE REQUIRED AT ALL TIMES DURING THE MASSAGE. *
I will cancel my appointment if I feel any symptoms of illness. *No cancellation fee* *
I am not subject to any COVID-19 related quarantine. *
I do not currently have any symptoms of illness. I have not had any symptoms of illness for the past 14 days. *
If I have tested positive for COVID-19, I agree to wait for a negative test result before receiving massage. I must also agree that 14 days has passed since any sign of symptoms. *
I agree to wait at least 14 days and test negative for COVID-19 after recovering from any cold or flu before receiving massage. *
If I am asymptomatic but have tested positive for COVID-19, I must wait for massage until both testing negative and waiting at least 10 days since last testing positive. *
If I have been a close contact of someone who has tested positive for COVID-19, I agree to postpone the massage until at least one of the following requirements have been met:                                                                                    1.) asymptomatic for at least 14 days after exposure 2.) negative test result after waiting at least 5 days after exposure *
If you need to disclose further information regarding COVID-19 exposure or symptoms, please do so here. We will review your circumstances and inform you if you need to reschedule your massage.
I understand that massage therapy and the effects of COVID-19 have not been studied in relation to each other. Because massage involves touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. I also understand that massage is not recommended for anyone who has received a COVID-19 vaccine or booster within the past 48 hrs. By electronically signing this form, I acknowledge that I am aware of the risks involved and give consent to receive massage and bodywork from North Shore Integrated Massage. *
The information provided on this form will be used for all future appointments, and I will immediately update the therapist regarding any status changes for the purposes of COVID-19 screening. *
Enter any additional information your therapist should know about your health history and preferences for massage. *
My typed name below indicates that I agree to these conditions for receiving massage therapy from North Shore Integrated Massage LLC *
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