COVID-19 has been declared a worldwide pandemic by the World Health Organization.  COVID-19 is extremely contagious and is believed to spread mainly from person to person contact.  As a result, federal, state, and local governments and federal and state health agencies recommend social distancing.  Your massage therapist has put in place preventive measure to reduce the spread of COVID-19; However, your Massage Therapist cannot guarantee that you will not become infected with COVID-19.

Here is a list of preventative measures that Cheshire Massage put in effect:

1.    Clients must wear a mask from the moment they enter the clinic including for the duration of the massage.

• Face masks with an exhalation valve are not allowed. These masks only protect the person wearing them because the valve is one way.

2.    We will be taking the temperature of every client before they go in to their session. We use a touchless digital thermometer.

3. Services will be provided by appointment only.

• We are practicing social distancing in our scheduling, with extra time between appointments in order to thoroughly disinfect.

4. Clients must use hand sanitizer upon entering the spa.

5. All massage clients will fill out a waiver before receiving their service.

6. Massage therapists will wear a mask, eye protection, and latex gloves.

7. Please stand 6 feet from other clients.

8. Windows may be open for ventilation during your session if your room doesn’t have an air purifier.

9. A water barrier will be placed below the bottom sheet and thoroughly sanitized before and after each client.

10.  Clients over the age of 65 are discouraged from receiving a massage at this time.

PLEASE SEE BELOW FOR A LOOK AT OUR WAIVER

COVID-19 INTAKE FORM AND WAIVER

IN THE PAST 14 DAYS, I HAVE EXPERIENCED:

 FEVER 101 F

UNEXPLAINED BODY ACHES OR PAINS

 COUGHING

 SORE THROAT

 SHORTNESS OF BREATH

 CHILLS WITH OR WITHOUT BODY ACHES

 RECENT LOSS OF SENSE OF SMELL OR TASTE

 UNEXPLAINED SORES ON THE SOLES OF FEET

UNUSUAL FATIGUE 

NON-ALLERGY RELATED RUNNY NOSE

COVID-19 has been declared a worldwide pandemic by the World Health Organization.  COVID-19 is extremely contagious and is believed to spread mainly from person to person contact.  As a result, federal, state, and local governments and federal and state health agencies recommend social distancing.  Your massage therapist has put in place preventive measure to reduce the spread of COVID-19; However, your Massage Therapist cannot guarantee that you will not become infected with COVID-19.  By signing the agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by receiving Massage Therapy and that such exposure or infection may result in personal injury, illness, permanent disability, and death.  I voluntarily agree to assume all the forgoing risk and accept sole responsibility for any injury to myself (Including, but not limited to, personal injury, disability, and death), Illness, damage, loss, claim, liability, or expense of any kind that I may experience or incur in connection with my Massage Therapy appointment.  On my behalf I hereby release, covenant not to sue, discharge, and hold harmless my Massage Therapist, or Cheshire Massage, and any interested parties from the claims, including all liabilities, claims, actions, damage, cost or expense of any kind arising out of or relating thereto.  I understand and agree that this release includes any claims based on the actions, omissions, or negligence of my Massage Therapist or Cheshire Massage where my massage therapy services are received, whether a COVID-19 infection occurs before, during, or after any participation in a massage therapy service 

NAME:__________________________________________                       DATE:_________________