COVID-19 Massage Informed Consent and Intake Forms

With all of the new and rapidly changing rules and recommendations for starting to practice again post quarantine, it’s easy to feel overwhelmed! Modifying your informed consent and intake forms are among the most necessary to-do’s in order to reopen safely and with all of your bases covered. Below you’ll find sample language to consider adding to your existing informed consent and intake forms recommended by the Federation of State Massage Therapy Boards. 

Informed Consent Additions

In addition to your regular informed consent form, you may want to consider adding language specific to COVID-19. Here are a couple of suggestions:

“I understand that close contact with people increases the risk of infection from COVID-19. By signing this form, I acknowledge that I am aware of the risks involved and give consent to receive massage from this practitioner.” 

“I understand that my name and contact information might be shared with the state health department in the event that a client or practitioner at this business tests positive for COVID-19. My contact details will only be shared in the event they are relevant based on suspected exposure date, and only for appropriate follow-up by the health department.”

Additions to your current intake

Have you been asked to self isolate or quarantine by a doctor or a local public health official in the last 14 days? 

Have you experienced any cold or flu-like symptoms in the last 14 days (fever, cough, shortness of breath or other respiratory problem)? 

Have you had close contact with or cared for someone diagnosed with COVID-19, or someone exhibiting cold or flu like symptoms within the last 14 days? 

Have you been tested for COVID-19? What type of test did you have? When were you tested? What was the result? 

Consider adding the above questions to your intake, or click the link below to download a free Massage COVID-19 Intake Addendum.