COVID-19 Informed Consent Form

During the current outbreak the safety of our staff and clients is very important to us. We are staggering our appointments so that only one client and massage therapist will be in our reception area at a time. Please do not bring anyone with you to your appointment, and do not arrive prior to your allotted time so we can fully disinfect the clinic between clients. Please wait in your car and we will call you when we are ready for you to come inside. We have stepped up our hygiene protocols and will be wearing masks during our sessions. In addition, we are asking all clients to immediately wash your hands for twenty seconds upon entering our office before your massage, and to wear a mask while in our office and during your massage (you may remove your mask when lying face-down). We will have masks available, please let us know when we call you if you need one.

  • Fever
  • Fatigue
  • Dry cough
  • Difficulty breathing
  • Chills
  • Nausea or vomiting
  • Diarrhea
  • Confusion

Finally, I understand that because massage therapy involves close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form I acknowledge that I am aware of the risks involved and give consent to receive massage from my practitioner at Balanced Massage, LLC.

By signing my name below I agree to each of the above statements and release the massage therapist and Balanced Massage, LLC from any and all liability for the unintentional exposure or harm due to COVID-19.

Your massage therapist agrees that they will abide by these same standards and affirms the same. We also affirm that we have improved and expanded our sanitation and hygiene protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.

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