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Covid-19 Liability Release Form

Harmony Massage
Coronavirus Liability Release Form

Due to the outbreak of the Coronavirus, COVID-19, I am taking extra precautions with the intake of each client, health history review, as well as sanitization and disinfecting practices. Please complete the following and sign below.



Symptoms of COVID-19 include:

  • A high temperature

  • Shivering (chills)

  • A new continuous cough

  • A loss or change to your sense of smell or taste

  • Feeling tired and exhausted

  • Shortness of breath

  • New widespread muscle pain

  • Headaches

  • Difficulty breathing

  • Nausea or vomiting

  • A Blocked or runny nose

  • A sore throat

  • Diarrhea cramping in lower legs and feet

​If you have any of the above symptoms you will need to take a rapid lateral flow or PCR test prior to your appointment. However if you are feeling unwell I wont be able to treat you regardless of the result.

​I agree to the following:

Please tick each box *

By signing below I agree to each above statement and release the massage therapist and business from any and all liability for the unintentional exposure or harm due to COVID-19.

Your massage therapist agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitization protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.

Thanks for submitting!

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