INTEGRATIVE HEALTH MOBILE SERVICES

POWER OF THE HEALING TOUCH AT YOUR DOORSTEP

Integrative Health Mobile Services is a Southwest Edmonton based mobile massage business established to bring much needed massage services to clients right in their own homes or office. Serving the areas of Edmonton, Leduc, St. Albert, Sherwood Park, Beaumont, and Spruce Grove

I am doing massages in my home during the day. Clients are welcome to come over in the evening as well. My massage room is at the front of the house with a bathroom close by, so you will be separated from anyone else in the house, and you will have your own clean towel to use.

When I arrive at your home, I will now be wearing a mask, as it will not be possible to keep a safe distance. You are not required to wear a mask, unless you feel you want to. If you or anyone in the home are not feeling well, we will cancel and reschedule the appointment for a later date.

COVID-19 PRE-SCREENING CHECKLIST
Answering YES to any of the questions below indicates that an individual is symptomatic of COVID-19, or may have been exposed to COVID-19. Individuals should be told to self-isolate and call Health Link 811. Please do not fill this form out until you have booked an appointment. You can use the form in the "Contact" section to email me first. Once you have booked an appointment then you can fill this form out.

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Name *

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Last

Email *

Phone Number *

Do you have a fever? *

Do you have a new or changed chronic cough? *

Do you have a sore throat that is not related to a known or pre-existing condition? *

Do you have a runny nose that is not related to a known or pre-existing condition? *

Do you have nasal congestion that is not related to a known or preexisting condition? *

Do you have shortness of breath that is not related to a known or preexisting condition? *

Have you traveled internationally within the last 14 days? *

Have you had unprotected close contact with individuals who have a confirmed or presumptive diagnosis of COVID-19 (e.g. individuals exposed without appropriate PPE in use) *

Additional Comments *

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POWER OF THE HEALING TOUCH AT YOUR DOORSTEP