Mei Leslie, LMT, CST-T
MEI LESLIE, LMT, CST-T
Welcome
Therapies
Craniosacral Therapy
Oncology Massage Therapy
Biomat Far Infrared Therapy
FAQs
FAQs
Intake Forms
Gift Certificates
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BodyWork in the Time of Covid
BodyWork in the Time of Covid
COVID19 Waiver
COVID19 Questions
Memorial Re-Opening Letter
Shelter in Place Letter
Mei Leslie, LMT, CST-T
Mei Leslie, LMT, CST-T
Training
Selah Massage & Bodywork ~ COVID19 Pre-Appointment Questionnaire
This Form or the
printable version
must be submitted before each treatment session beginning June 2020.
COVID19 Pre-Appointment Questionnaire
*
Indicates required field
Name:
*
First
Last
[object Object]
Appointment Date:
*
1. Have you had a a fever in the last 24 hours of 100°F or above?
*
Yes
No
2. Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath?
*
Yes
No
3. Do you now, or have you recently had, any chills, muscle aches, new loss of taste or smell, or new rashes or lesions?
*
Yes
No
4. Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID19 or has coronavirus-type symptoms?
*
Yes
No
Submit