INFORMED CONSENT

Understanding the Changes to Treatment

Agreements

  • If I answer "YES" to ANY of the questions in the BC COVID-19 Symptom Self Assessment Tool completed before a treatment, I agree that for my safety, and the safety of others, I will cancel my RMT appointment immediately and will not attend.

  • I will follow up with the steps and isolation period recommended on the Self Assessment Tool before booking another treatment.

  • I understand that late cancellation fees will not apply when symptoms appear within the 24-hr period.

  • In the case I test positive for COVID-19 within 2 weeks of a treatment with Renee, I will contact her via email to inform her.

Initial ______

  • I have read the Return to Practice Plan posted on www.reneermt.com and agree to follow the procedures put in place.

Initial ______

 

Informed Consent

  • I understand that COVID-19 is extremely contagious and is spread by respiratory droplets generated when a person speaks, coughs or sneezes; close, prolonged personal contact; and touching your mouth, nose or eyes after touching a contaminated surface.

  • Current evidence suggests person-to-person spread is efficient when there is close contact and as a result, federal and provincial public health organizations recommend physical distancing. I recognize that due to the nature of massage therapy, I will not be able to maintain physical distance (2 metres distance) from my therapist and we will share an enclosed room for the duration of treatment.

  • I understand my therapist has taken preventative measures as required by the College of Massage Therapists of BC and the British Columbia Centre for Disease Control to reduce the risk of transmitting COVID-19 and other infectious diseases. I am aware that despite these measures, the risk of infection remains during interactions in the clinic and during treatment.

  • I understand no appointment is risk free even if the patient and therapist appear well.

  • I understand that the therapist is not confined to home and 1005 Cook Street exclusively, interacts with the general public, and may be exposed to COVID-19 outside of the clinic.

  • I accept this risk and would like to proceed with massage therapy. This consent is considered to be valid over the entire course of my treatment during the COVID-19 pandemic. I understand that I may withdraw my consent at any time.

  • I have been given the opportunity to ask any questions I may have and discuss the risks of massage therapy.

 

Waiver

I release the therapist, Renee Tong, of any liability and waive all claims if I contract COVID-19 before, during, or after a massage treatment.

 

Initial ______

 

I give my therapist permission to share my personal information for contact tracing in the case a patient or therapist tests positive for COVID-19.

 

Initial ______