Season of Healing Massage & Bodywork

Confidential Client Health Form & Consent to Treat

Phone: 355-9935

Thank you for completing this form before your appointment.

Confidential Health Intake Form

We ask that you be completely honest in your health intake responses and refrain from coming in if you have any COVID-19 symptoms or other communicable concerns that would be detrimental to the practitioners and other clients in our office.

Do you text?

Have you received a Covid 19 Vaccination?

Have you been confirmed positive with COVID-19?

Have had any COVID-19 symptoms in the last 14 days; fever, cough, shortness of breath?

Have you been in close contact with individuals who have been confirmed positive for COVID-19?

Have you recently traveled to an area that is considered a COVID-intensive area?

Have you been in contact with other individuals who have traveled to a COVID-intensive area and are exhibiting acute respiratory illness symptoms?

Do you have an Autoimmune Disease?

Do you experience blood clots?

Have/Had cancer?

Experience abnormal skin condition?

Do you have High/Low Blood Pressure?

Do you have Varicose Veins?

Do you have Diabetes?

Do you experience Headaches or TMJ

Do you have structural/muscular concerns?

Are you pregnant?

7 + 15 =