ISLANDTOUCH MASSAGE & SPA, INC.
MM 13235 772-286-8699
PREPARATION FOR TREATMENT
It is three long and difficult months since I saw you. I hope that in spite of the current spike of cases in our area, I will be ready to re- open in a few weeks.
In order to comply and enhance your safety and mine we have made some changes to the way we were accustomed to doing business here. I am sure, of course, that you will be compliant as we navigate ways to avoid any likelihood of cross contamination in our space. We cannot make government permission to work the only element of my decision about whether and when to reopen. We have to consider all the variables like the current spike, level of testing, and the psychological effects of the vulnerable population. As such, we have to assume that everyone who walks through our door is an asymptomatic carrier of the virus and could be contagious.
- To that end, PPE will be worn by me for all services, during service and until each client leaves. I will have a change of smock in between clients.
- Expect to have your temperature taken upon arrival. Please leave your forehead uncovered up to 10 minutes for accurate readings.
- You will be expected to arrive wearing a mask at all times, and to wash your hands before entering room, at checkout, and upon leaving.
- Our A/C now has Halo sanitizer which uses hydrogen peroxide installed for overall and ongoing disinfection of surfaces.
- We have installed touchless soap and hand sanitizer, paper towel dispensers.
- Full room sanitation will be done between clients using hospital grade sanitation wipes and spray.
- Vacuum for carpet will have Hepa filter. Mat, drapes, décor removed.
- For the time being, face and scalp or areas with open wounds will not be touched.
- Clothing should be folded and place in container provided.
- Please leave personal items in your car: handbag, phone, jewelry etc.
- If you think or feel you are sick, DO NOT COME IN.
- Services will be 60 minutes long. We are suspending 90 minutes services in order to limit close exposure.
- NEW RATES EFFECTIVE IMMEDIATELY ARE POSTED ON WEBSITE.
My goal is to practice safely with you in mind, ethically and legally with OSHA and CDC guidelines.
In accordance with extended shelter-in-place recommendations to protect our more vulnerable populations, I am not working with clients with compromised immune systems, clients aged 65 or above, or clients in other elevated at-risk categories at this time.
ISLANDTOUCH MASSAGE & SPA, INC. MM13235 772-286-8699 WWW.ISLANDTOUCHMASSAGE.COM
To proceed with receiving care, I confirm and understand the following (initial in all places provided)
I understand that the novel Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). I further, understand that COVID-19 is extremely contagious and may be contracted from various sources. I understand COVID-19 has a long incubation period during which carriers of the virus may not show symptoms and still be contagious. ________
I understand that I am the decision maker for my health care. To the best of their ability, my practitioner will provide me with information to assist me in making informed choices. This process is often referred to as “informed consent” and involves my understanding and agreement regarding recommended care, and the benefits and risks associated with the provision of health care during a pandemic. Given the current limitations of COVID-19 virus testing, I understand determining who is infected with COVID-19 is exceptionally difficult. ________
I understand that preventive measures and intensified sanitation protocols intended to reduce the spread of COVID-19 have been implemented. However, because this work involves close physical proximity over an extended period of time in a closed space, there may be an elevated risk of disease transmission, including COVID-19. I hereby acknowledge and assume the risk of becoming infected with COVID-19 through this treatment and give my permission to you and the staff at your office to proceed with providing care. __________
I have been offered a copy of this consent form. ___________
I KNOWINGLY AND WILLINGLY CONSENT TO THE TREATMENT WITH THE FULL UNDERSTANDING AND DISCLOSURE OF THE RISKS ASSOCIATED WITH RECEIVING CARE DURING THE COVID-19 PANDEMIC. I CONFIRM ALL OF MY QUESTIONS WERE ANSWERED TO MY SATISFACTION.
“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 facility 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.”
I HAVE READ OR HAVE HAD READ TO ME, THE ABOVE COVID-19 RISK INFORMED CONSENT TO TREAT. I APPRECIATE THAT IT IS NOT POSSIBLE TO CONSIDER EVERY POSSIBLE COMPLICATION TO CARE. I HAVE ALSO, HAD AN OPPORTUNITY TO ASK QUESTIONS ABOUT ITS CONTENT, AND BY SIGNING BELOW, I AGREE WITH THE CURRENT OR FUTURE RECOMMENDATION TO RECEIVE CARE AS IS DEEMED APPROPRIATE FOR MY CIRCUMSTANCE. I INTEND THIS CONSENT TO COVER THE ENTIRE COURSE OF CARE FROM ALL PROVIDERS IN THIS OFFICE FOR MY PRESENT CONDITION AND FOR ANY FUTURE CONDITION/S FOR WHICH I SEEK CARE FROM THIS OFFICE.
Client Signature: _________________________________ Date: _______________
Parent or Guardian for Minor: __________________________ Date: _________________