Mei Leslie, LMT, CST-T, CMLDT
MEI LESLIE, LMT, CST-T
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Therapies
Craniosacral Therapy
Oncology Massage Therapy
Manual Lymph Drainage
Biomat Far Infrared Therapy
Meet Mei Leslie
Mei Leslie
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Intake Forms
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Selah Massage & Bodywork ~ COVID19 Liability Waiver
This Form or the
printable version
must be submitted before your first session beginning June 2020.
COVID19 Liability Waiver
*
Indicates required field
Name
*
First
Last
Consent for Treatment:
Check the box and click submit to grant Consent for Treatment
*
I understand that, because therapeutic bodywork involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID19. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the therapist/business from any claims related thereto. I give my consent to receive treatment from this therapist. Clicking the Submit button will act as my signature.
Appointment Date:
*
Submit