• I accept the following affirmations when engaging in a massage from a Good Sign Registered Therapist.

• I understand the above symptoms and affirm that I, as well as all members of my household, do not currently have nor have experienced COVID-19 within the last 14 days.

• I claim that I, as well as members of my households, have not diagnosed with COVID-19 within the last 14 days.

• I claim that, to my knowledge, I have not been in contact with anyone who has been diagnosed with COVID-19.

• I claim that if I traveled outside of Canada in the last month, I isolate myself in my home for 14 days upon my return.

• I understand that this business and my Good Sign Massage Registered Therapist can not be held liable should I experience exposure to the virus or any other contagion as a result of my providing misinformation on this form.

• I understand that because massage therapy and other natural health practices involve maintaining prolonged and close physical contact, there may be an elevated risk of disease transmission, including COVID-19.

• I acknowledge that I am aware of the risks involved and give consent to receive massage therapy by signing this form.