08/26/2020
After taking some time off to consult with Ventura County Health, Dr's and the SBDC... I have been seeing clients with my new protocol since June 5th. I look forward to seeing you and please feel free to call with any questions. Thanks, Tom
COVID-19 PROTOCOL
for working with Tom Marshall
The health and safety of my clients and my family is my priority. If you have any questions or concerns, we will discuss them before your appointment. If you are not comfortable with this protocol for any reason we can reschedule after the Covid-19 pandemic.
For appointments with Tom Marshall, you are required to be following CDC guidelines when in public: Wearing masks, Social distancing and Washing hands often…
Facemasks are required before entering the office and until you leave.
If you arrive early, please wait in your car until your appointment time or call Tom on his cell phone to make sure no one else is in the office. The waiting room is closed for the pandemic season.
The office will be sanitized before and after appointments including all working and contact surfaces and the restroom.
The air and all surfaces will be sanitized with Ozone and Ionization at safe low levels when occupied and at higher levels when no one is in the office. The HEPA air filter is running when office is occupied.
There will be hand sanitizer to use when needed and after making payments.
I will take your temperature every time, when you arrive, with a Non-Contact Thermometer and take a Pulse Oximeter reading. They will be sanitized after each use.
COVID-19 Related Questions will be asked each time you come in for an appointment.
1. Have you had a fever in the last 24 hours of 100°F or above? Yes ☐ No ☐
2. Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath? Yes ☐ No ☐
3. Do you now, or have you recently had, any chills, muscle aches, new loss of taste or smell, or new rashes or lesions? Yes ☐ No ☐
4. Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms? Yes ☐ No ☐
I understand that Hellerwork Structural and Movement Integration therapy involves hands on manipulation of fascia and close physical proximity during a 90-minute session, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved and give consent to receive Hellerwork from Tom Marshall.
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Signature Print Name
Date___________________ Temperature________ Oximeter________ Pulse________
