Medical Update Form (Form B)

Have there been any changes to your Medical history since your last appointment? *

No

Yes

If "Yes", please explain:

* Please keep in mind that we no longer offer full-body 60-minute services. 60-minute services are now upper-body and feet only. Please select a 90-minute service for full-body service.

Which service are you coming in for? *

60-minute / Upper-body

90-minute / Full-body

What areas would you like to focus on during the appointment? *

Additional Information:

COVID, Cold / Flu Information

Please email pttm.info@gmail.com to cancel your appointment if, in the last 10 days, you have:

1). Had a positive COVID test or are waiting for the result.

2). Had any symptoms of COVID or a Cold/Flu (New-onset Sore Throat, Runny Nose, Cough, Fever, Fatigue, Chills, Loss of sense of smell or taste).

3). Have been in contact with someone with COVID.

Business - COVID Declaration

I agree to the following:

Premiere Touch Therapeutic Massage, LLC is following these enhanced procedures to prevent the spread of COVID:

* Prepayment for services is available if clients prefer contactless checkout.

* Additional time included between appointments to prevent guest contact with each other.

* Guests accompanying those scheduled for services are not permitted.

* Each guest is required to use hand sanitizer or wash hands upon arrival.

* Your Therapist will thoroughly clean their hands prior to each session and will wear sterile gloves if necessary for consultations and treatments.

* Your Therapist will wear the following protective gear: mask and (optional) face guard for each appointment.

* All product bottles used during the treatment will be placed in a separate container for disinfection and disposable items will be used when possible.

* All surfaces will be wiped thoroughly with hospital-grade disinfectant before and after each client according to the manufacturer's directions and sterilized at the end of each day.

To assist us in our efforts of reducing the spread of illness, face masks are still required while in the office.

I understand that Premiere Touch Therapeutic Massage, LLC cannot be held liable for any exposure to viruses caused by misinformation on this form or the health history provided by each client. *

I understand

Today's Date: * +

Print Full Name (First and Last / No Initials): *

No area of focus	Neck	Pectorals	Shoulders
Mid-Back	Lower-Back	Glutes	Hamstrings
Quads	Calves	Feet	Arms / Hands