covid intake form — Every Body Massage Therapy

COVID-19 specific intake form

As COVID-19 is a relatively new virus data around risk factors and long term effects is still being gathered. While massage therapy is an incredibly soothing and nourishing experience when coming out of such a big experience, it is important to make sure we are acting within the capacity of your body as it heals. Below are a few questions aimed at getting a handle on how COVID-19 may have effected you, if massage is safe for you at this time and how best to tailor your appointment for your needs.

Name

First Name

Last Name

When did your symptoms start

When did you get a positive test

What kind of medical care did you receive?

Eg: managed at home with panadol, spoke to my GP, went to hospital, took specific medications etc.

Are you taking blood thinners or any other medications as a result of your COVID-19 infection?

Eg: walking short distances makes me out of breath, sleeping is hard because I'm in pain etc

Do you have any long term impacts of your COVID-19 infection

eg: Kidney damage, lung damage, excessive fatigue, shortness of breath, unrelenting muscle pain etc

Have you had any advice from health professionals about return to activity or about your recovery as a whole?

this includes daily activity such as leisure activities, things around the home, return to paid work or exercise

Anything else you would like me to know?