COVID-19 InOrMed Consent FORM
By signing below, I acknowledge that I understand that close contact with people increases the risk of infection from COVID-19. I am further aware that massage requires close contact with my massage practitioner (Kirsten DeLuca). I am also aware that close contact within a small confined space over a sustained period of time is also believed to increase the risk of infection from COVID-19. I am aware that Kirsten DeLuca provides massage within a 140 square foot office without access to outside air flow and I am aware that most massage sessions are at least 60 minutes in length. By signing this form, I acknowledge that I am fully aware of the increased risk of infection from COVID-19 from sustained close contact within a small confined space without outside air flow and I give my informed consent to receive massage from Kirsten DeLuca under these conditions.
I agree to abide by the safety guidelines used by Kirsten DeLuca in her massage therapy practice to reduce the possibility of COVID-19 transmission. Specifically, I agree to:
reschedule my massage session if I experience coronavirus-type symptoms or a possible exposure,
complete a brief COVID-19 Health Screening Form no more than 24 hours before every appointment, and
allow Kirsten DeLuca to take my temperature at the start of every appointment.
I understand that my practitioner will participate in contact tracing if necessary and that in such an instance my name and contact information may be shared with state agencies.
I further attest that should I, within 14 days of my appointment, test positive for COVID-19, experience any coronavirus-type symptoms, or learn that I was previously exposed to someone else with a COVID-19 diagnosis or COVID-19 symptoms, I will contact Kirsten DeLuca immediately with this information.