Email Us!
A New Truly
About Truly Bodywork, Inc.
About Your Massage Therapist
Why the Change?
Cancellation Policy
Massage and Bodywork Services
CBD Sports Deep Tissue MT
Rehabilitative Massage Therapy
Sports Massage Therapy
Cupping Therapy Massage
Essential Oil Sports Massage
IASTM
Times and Location
901 Sneath Ln, Suite 115
This document contains important information about your decision to receive services in light of the COVID-19 public health crisis. Please read and fill out this form carefully and let me know if you have any questions.
*
Indicates required field
Name
*
First
Last
Email
*
Have you been tested for COVID-19?
*
Yes
No
If Yes, what was the Result
*
In the Last 14 days, have you been in contact with anyone who has been diagnosed with COVID-19 or has had CoronaVirus-type symptoms.
*
In the Last 14 days, have you been asked to self-isolate or quarantine by a doctor or local public health official?
*
In the Last 14 days, have you been somewhere with a high infection rate?
*
Do you now, or have you recently experienced, any of the following as a NEW PATTERN since the beginning of the pandemic:
*
NO
If YES, please check all that apply
Fever
Chills
Shortness of Breath
Cough
Sore Throat
Nasal or Sinus Congestion
Loss of Taste or Sense of Smell
Persistent Chest Pain or Pressure
Discomfort with exertion or exercise
Diarrhea or digestive upset
Skin Marks, lesions or rashes (especially on the feet
Fatigue
Sudden onset of muscle soreness (not related to a specific activity
Discomfort with exertion or exercise
If you tested positive for COVID-19 or believe you may have had COVID-19, but were not tested:
*
This does not apply to me because I have not tested positive for Covid-19.
My medical doctor has cleared me to return to work or to end self-isolation?
My medical doctor advised me to return to normal activity levels?
I am not taking any drugs to manage blood clotting.
Describe your Daily Physical Activity (Work, School, Exercise) since the pandemic.
*
Thank you for filling out the Covid-19 paperwork for Truly Bodywork. We will contact you after receiving your completed information to confirm your appointment.
Submit