COVID-19 SampleQuestionnaire & Agreement:

By attending my appointment

I agree that I am not currently experiencing any of these symptoms:

  • Cough
  • Shortness of breath or difficulty breathing

I agree that I am not experiencing two or more of these symptoms:

  • Fever
  • Chills
  • Repeated shaking with chills
  • Muscle pain with accompanying fever/chills, sore throat etc. 
  • Headache
  • Sore throat
  • New loss of taste or smell

I agree that I have not:

  • Tested positive for COVID-19
  • Knowingly been exposed to someone with COVID-19
  • Recently traveled to an area with a high infection rate
  • Been in an area where social distancing was not properly observed
  • Been to a nursing home 

If you have experienced any of the above, please reschedule your appointment at least 14 days from now.

__________________________________________

Copy of Email Sent to all Clients upon Reopening Clinic, June 8th, 2020

Things may look a bit different at my home clinic in that, the room may look a little bare as I have removed some things that were purely decorative so as to reduce the number of possible surfaces and materials that could be in contact with clients or myself.

I do ask, if possible, that clients bring their own mask. My own use of PPE, special sanitizing supplies etc. will add to my costs (which I will absorb for now); and to supply masks to all of my clients would further exacerbate those costs for me. I may be able to supply a mask if necessary, for a donation of $2 towards covering the cost. None the less, my supply of masks may be restricted due to market availability. If I run out, then it would be necessary to close the clinic until supplies can be replenished.

There will be a link to a screening questionnaire attached to the reminder notices that you receive just prior to your appointment. This must be completed before you arrive. A sample of a similar set of questions is available on my website www.davidzulak.com under the COVID-19 tab. I suggest that you read that over before booking so that you know what will be asked in the screening questionnaire that will come with your reminder notice. If you are being accompanied by someone then I suggest they look at the questionnaire before coming. I will have a copy that they can initial upon arrival.

RMTs may only provide healthcare services in accordance with directives from the Ontario Chief Medical Officer of Health, along with legislation regarding all health care workers in the province. Accordingly, specific to massage therapy the CMTO (College of Massage Therapist of Ontario) have outlined a number of necessary prerequisites.

The following are a summarised version of the requirements for treating clients at this time:

• In-person Massage therapy treatment should only be provided when the anticipated benefits of treatment outweigh the risks to the client and the RMT. As most of my clients see me to treat specific concerns most will meet this requirement.

• The client must answer a screening questionnaire prior to each treatment. (This will be attached to the emailed or text reminder notice given just prior to the treatment date.). The client ideally should arrive alone, but if accompanied by someone assisting you, that person must also complete a screening questionnaire upon arriving.

• As usual sanitization of the reception & treatment areas will be done prior to and after each session, and will included the heightened measures suggested by my College (CMTO) and public health professionals during the pandemic. I have accordingly added more time between all appointments to ensure that this is thorough.

• Please arrive no earlier than 5 minutes prior to your appointment. If you arrive earlier, please stay in your vehicle.

• Those arriving need to be wearing an acceptable PPE mask before entering the clinic and both the therapist and the client, (and any accompanying person), must wear appropriate masks throughout the treatment. Otherwise, the treatment session cannot begin, nor continue if removed.

• Upon arrival clients are required to wash their hands. Also, hand-washing before leaving is required. Instructions for this will be mounted in the washroom.

• Regarding payment, contact (“tap”) of a credit or debit card is preferred.

• Further, as a record of each visitor to the clinic needs to leave their contact information for the purposes of contact tracing; therefore, all current phone numbers and address need to be confirmed for clients; and those who may accompany a client (into the clinic) must also leave their contact information.


I can provide further details concerning the requirements issued by Public Health and the College of Massage Therapists of Ontario upon request.


Style of treatment. While I can provide treatment with the client draped and use lotion, there are other options available for those who might feel more comfortable remaining dressed and/or seek alternative approaches to treatment.


For many years now I have treated a large percentage of my clientele dressed in loose clothing or athletic wear. This style of treatment incorporates a number of osteopathic techniques, plus various forms of stretching, along with some kneading and acupressure. It is based on what once was called “General Osteopathic Treatment” in North America, and on the British version called the “Total Body Adjustment”. Use of gentle percussive devices have often been employed by me as well during such treatments.


Such treatments are usually 30 or 45 minutes long. This approach is highly effective for all types of musculoskeletal issues as well as circulatory & lymphatic concerns, and also be employed for basic stress relief and relaxation. Most of my clients over the years have remarked that my style of massage is somewhat unique when receiving massage with draping and lotions, and this is so because a number of the techniques mentioned above have been incorporated into my treatment approach. Therefore, if you are a client who previously received only draped treatments with me many of the elements of a dressed treatment may well be familiar to you. Please specify upon arrival (or in an email prior to arrival) that you wish the dressed form of treatment if that is not the usual manner in which I have treated you in the past.


Thank you,

David Zulak RMT

For how long is dependent on how the pandemic demands self-isolating and social distancing. how long is dependent on how the pandemic demands self-isolating and social distancing.