Trevor and Leslie Browning 970-708-4974
970-708-4974 Professional Massage Therapy and Bodywork in Telluride Mountain Village

Client Forms

Taking practical precautions for prevention of spreading virus 

Have you had a fever in the last 24 hours of 100°F or above?

Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath?

Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms?

 I understand that, because massage therapy work involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved and give consent to receive massage and bodywork from this practitioner.

https://dzdx4ocwzatbw.cloudfront.net/pdf/business-management/client-forms/Screening-Questionnaire_COVID.pdf

Health Information form
Screening Questionnaire form
Body Map for Clients
Health Status Update form
Client Feedback form
Physician's Permission form
Physician's Referral form
Billing Information form

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