The following risk and contact tracing consent form will be emailed to you one day prior to your massage appointment. If possible, please compete and sign it online to save time during your appointment.


If it is not compete, we will complete it before your massage begins.


If you have any concerns with this consent that may lead to you to canceling your appointment, you must follow the cancellation policy, or a late cancel fee will apply.

informed consent

I understand that COVID-19 is highly contagious and still present in the community where I am seeking massage therapy.

I understand that COVID-19 is passed through close contact with others and that people without symptoms may be infectious.

I understand that this massage business has taken every precaution to ensure my health and safety but that risk of infection is still possible. 

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.

high risk awareness


I understand that the heath conditions listed below place me at higher risk for serious COVID-19 infection.

If I have one of these conditions I am making the decision to proceed with massage therapy I assume all risk related to COVID-19 infection. High risk conditions include: 


Chronic lung diseases 
People 65 years or older
Moderate to severe asthma 
Cardiovascular conditions 
Compromised immunity 
Suppressed immunity (e.g., medication) 
Severe obesity (BMI 40 or higher) 
Chronic kidney diseases
Liver diseases

dept of health tracing

I understand that in the event that a client or my massage therapist tests positive for COVID-19 within a time period that places me at risk of exposure, my name and contact information will be shared with the State Department of Health for their follow-up.

In the event that I develop symptoms of illness within two weeks of my massage appointment, I will contact Massage Sci immediately.