COVID-19 Patient Daily Intake Consent

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I understand that while the therapist is following all of the health and safety guidelines outlined by the Registered Massage Therapists Association of British Columbia, the College of Massage Therapists of British Columbia, and the Provincial Health Officer and that they are taking all reasonable precautions to clean and disinfect the clinic and all the surfaces within the treatment room, there are no guarantees that I may not come into contact with COVID-19.
I certify that the above medical information is correct to my knowledge.
  • Do you have a fever, a new cough, a worsening chronic cough, shortness of breath or difficulty breathing? 
  • Have you had close contact with anyone with acute respiratory illness or have you travelled outside of British Columbia in the past 14 days?
  • Do you have a confirmed case of COVID-19 or had close contact with a confirmed case of COVID-19? 
  • Do you have 2 or more of the following symptoms: sore throat, runny nose/sneezing, nasal congestion, hoarse voice, difficulty swallowing, decrease or loss of sense of smell or taste, chills, unexplained or unusual headaches, unexplained fatigue/malaise, diarrhea, abdominal pain or nausea/vomiting?
  • If you are over 65 years of age, are you experiencing any of the following: feeling confused, severe chest pain, falls, losing consciousness, speaking in single words or worsening of chronic conditions? 
  • Are you aware of anyone in your circle of contacts presenting with any of the above symptoms of COVID-19?

 

I understand that while the therapist is following all of the health and safety guidelines outlined by the Registered Massage Therapists Association of British Columbia, the College of Massage Therapists of British Columbia, and the Provincial Health Officer and that they are taking all reasonable precautions to clean and disinfect the clinic and all the surfaces within the treatment room, there are no guarantees that I may not come into contact with COVID-19. 


I certify that the above medical information is correct to my knowledge.

 

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Hands-On Healing

2363 Enterprise Way

Kelowna, BC V1X 7K2

Hours

Monday & Wednesday: 9:00 AM - 3:00 PM
Tuesday & Thursday: 8:30 AM - 4:30 PM
Friday: 8:00 AM - 12:00 PM
Hours may vary

Service Area

Kelowna & surrounding area

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