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Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

matthew@toucheducation.com

nicole@toucheducation.com

FSMTA

CE Broker

National Certifcation Board of Therapeutice Massage and Bodywork

American Bodywork and Massage Professionals

50-9319

450438-07

Locations:

Garden Of Eden Massage
4342 Harrison Ave
Cincinnati, OH 45211

Practice Yoga Cincinnati
7745 Five Mile Rd
Cincinnati, OH 45230

Mailing Address

4564 Fehr Rd

Cincinnati, OH 45238

Florida Info

(407) 308-2110

MM# 35669

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