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.
Now please also complete the Consent to Treat. Thank you.
Season of Healing Massage & Bodywork
Consent to Treat
- I hereby authorize, Season Smith, LMT to provide any and all forms of treatment, evaluation and therapy that may be indicated in connection with my care.
- In light of the present conditions associated with COVID-19, I will be honest with my responses when asked about my health during the pre-appointment consultation, and at the time of my appointment.
- I understand that my therapist has the right to refuse treatment if she feels that my health condition is not in the best interest of myself or the office at the time of my appointment.
- I will not hold Season of Healing Massage & Bodywork, or Season Smith LMT, responsible if I contract COVID-19 knowing that everything possible has been done to prevent exposure, yet there will always remain a risk.
- I have been given the opportunity to review the Document “COVID-19 Reopening Guidance, Governor’s Economic Reopening Taskforce” and understand that all guidelines will be met by myself and Season Smith, aka Season of Healing Massage & Bodywork.
- I understand that I will be texted or called just prior to my appointment time and will remain in my vehicle until given the okay to enter the building (VIA VERNON STREET), avoiding all surfaces in the shared reception area.
- I will wear a face covering upon entering the building and throughout my treatment.