COVID-19 Screening Form
Due to the COVID-19 global pandemic, I ask that you complete this
survey prior to arriving at the massage studio.
Please complete this survey one to two days before each appointment
I will not be able to accommodate your appointment without
having received this survey before you arrive at the
View as single page
Please enter the same email address that was used to book your
appointment on MassageBook.
If you are experiencing symptoms related to COVID-19, I ask that you
do not come to the massage studio at this time. Please reschedule
your appointment for a later date.
Symptoms are listed below:
Fever, cough, shortness of breath, or difficulty breathing
Have you had any of the following symptoms within the last two weeks:
Please click "Submit Responses" below to submit your survey responses.
Thank you for your cooperation. I will contact you if I need further
If you have questions, please call or text Derek at 612-367-6773, or