COVID-19 Form

Home
- Login
- COVID-19 Form
About me
Tips

Home
- Login
- COVID-19 Form
About me
Tips

Massage Therapy in STITTSVILLE, ON

613-836-0033

This email address is being protected from spambots. You need JavaScript enabled to view it.

COVID-19 Screening

Please complete the screening form before booking.

Name(*)

Invalid Input

Email Address(*)

Invalid Input

Phone Number(*)

Invalid Input

Have you traveled in the past 14 days?(*)

YES
NO

Invalid Input

Are you feeling UNWELL, or have a family member who's feeling UNWELL(*)

YES
NO

Invalid Input

I have had contact with some with COVID-19, or who has had COVID-19(*)

YES
NO

Invalid Input

I have a COMPROMISED IMMUNE SYSTEM

YES
NO Invalid Input

I have had a COUGH or FEVER in the past 14 DAYS

YES
NO Invalid Input

By booking your appointment, you are agreeing that Jennifer Sheehan RMT holds no liability if you contact COVID-!9 during your visit. (*)

I accept

Invalid Input

I am taking every precaution to minimize the risk.

You must wear a mask for the massage I will wear a mask for the massage.

Based on the information provided your risk factors are high. Please contact me by email for more information, or self isolate for 14 days and try again.

Thank you

Get Directions

Address

7 Renshaw Ave, Stittsville, On

Phone

613-836-0033

Email

This email address is being protected from spambots. You need JavaScript enabled to view it.