Sample Consent Forms

East Vancouver Therapeutic Massage Clinic

Patient’s Name

· I agree to wear a mask during my entire visit to East Vancouver Therapeutic Massage Clinic

· I will wash my hands upon entry/re-entry into the clinic and promptly after my treatment is 

  finished

· I will wait in my vehicle or outside and only come in when indicated by my RMT

· I will enter the clinic alone unless I require physical and/or communication support

· I will strictly follow the 2 metre physical distancing rules within the clinic wherever possible

· I will leave promptly after my appointment

· I will read the new protocols available on the clinic website www.eastvancouvermassage.com

  and follow all of the necessary steps to prevent the spread of COVID-19

· I understand my RMT may refuse to provide treatment when the risks of receiving or giving

  a treatment outweigh the possible benefits of treatment

The information listed on this page is based on current recommendations from health and safety regulatory bodies. The content is subject to change due to the unknown characteristics of COVID-19 and the global pandemic. A new signature is required with any change to the consent form.

I verify the information I have provided on this form is truthful and accurate. I have read and fully understand that ANY massage therapy treatment involves some risk of COVID-19 transmission. I voluntarily give consent to receive massage therapy during this COVID-19 

pandemic.

Patient Signature______________________  Date___________________