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  • 375 Bay Road Suite 104 Queensbury. NY 12804

    518-615-4622
  • COVID-19 Probable or Confirmed Survivor Consent Form

    ***PLEASE Fill Out 24 hours BEFORE coming in for your appointment to AVOID cancellation of your scheduled appointment.***
  • Because COVID-19 is a NEW phenomenon with lots of variations, safety is very important when receiving massage therapy and bodywork AFTER recovering from COVID-19. Blood clotting is one important issue that you as a COVID-19 survivor may face. Answering the following questions will be the most important information you can provide to help in making sure that we keep your massage and bodywork safe and within the limitation your body can tolerate.

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  • I AFFIRM that at have answered ALL questions on this form truthfully and honestly so that the safest massage therapy session can be given. I give my consent for my massage therapist, Grace McDonald, to contact my medical doctor above, if necessary, to ask any questions relating to their medical advice and treatment in order for my therapsit to determine how to safely proceed with my massage therapy session.

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