For all of our safety, please fill this out 24 hours prior to each massage (until further notice). Be sure that the information you'll give is accurate and complete. Please get immediate medical attention if you have any of the severe COVID-19 signs.

    Name *
    Email *
    Phone Number *
    In the past 14 days, I have experienced...
    Fever 101°F/38°C +
    Unexplained body aches or pain
    Sore throat
    Shortness of breath
    Recent loss of sense of smell or taste
    Chills with or without body aches
    Unexplained sores on soles of feet
    Unusual fatigue
    Non-allergy related runny nose
    Signature *