Pamela A. Renneberg (formerly Monarch) R.M.T, C.D.T, & Associates
Registered Massage Therapist - Combined Decongestive Therapy 
Assisted Device Program Authorizer

COVID-19 Individual Screening Guidance Document

1.Have you traveled internationally within the last 14 days (outside of Canada)?
___Yes
___No

2.Have you traveled outside of Ontario within the last 14 days?
___Yes
___No

3. Have you had close contact with a confirmed or probable COViD-19 case?
___Yes
___No

4. Have you had close contact with a person with acute respiratory illness?
___Yes
___No

5. Does the individual have a confirmed case of COVID-19 or had close contact with a confirmed case of COVID-19?
___Yes
___No

6.Does the individual have any of the following symptoms:
-fever
-New onset of cough
-Worsening chronic cough
-shortness of breath
-difficulty breathing
-sore throat
-difficulty swallowing
-decrease or loss of sense of taste or smell
-chills
-headaches
-unexplained fatigue/malaise/muscle aches
-nausea/vomiting, diarrhea, abdominal pain
-pink eye
-runny nose/nasal congestion without other known cause

7. if the individual is 70 years of age or older, are they experiencing any of the following symptoms:
-delirium
-unexplained or increased number of falls
-acute functional decline
-worsening of chronic conditions?

COVID-19 Screening Results

If response to ALL of the screening questions is NO…COVID Screen is Negative
If response to ANY of the screening questions is YES…COVID Screen is Positive
If the individual answers YES to any of the screening questions they cannot enter clinic.
Advise individual to contact health unit (519) 753-4937or Telehealth Ontario 1-866-797-0000 for further instruction


COVID-19 Waiver

The clinic of Pamela A. Renneberg & Associates is adhering to the directives provided by the Ontario Chief Medical Officer of Health, the Ministry of Health guidance for our health sector, and following workplace safety guidelines regarding Covid-19.  These measures are in place to address the health and safety of you our valued clients, and our therapists in order to reopen the clinic, and resume providing our health care services.

The College of Massage Therapists of Ontario has stated "Massage therapy treatment should only be provided when the anticipated benefit of treatment outweighs the risk to the client and RMT."

Due to the nature of the environment it will involve some risk of COVID -19 transmission as physically distancing is not possible during assessment and treatment.

If you feel the benefit of this treatment and subsequent treatments will outweigh any risk to yourself knowing the above standards are being followed, please sign this waiver providing consent to proceed with treatment.



Date:         ____________________________________________

Signature: ______________________________________

General Infection and Prevention Control Practices

The clinic will be resuming practice June 15/2020.
Please note we will be returning on a gradual basis, first prioritizing clients with urgent treatment needs. Fewer treatments per day will be provided to allow the clinic additional time between clients for enhanced cleaning and disinfecting.

The clinic has implemented many new policies and procedures based on the guidance of the Ministry of Health and the College of Massage Therapists of Ontario as you will note below.

Although the risk of contracting COVID-19 cannot be reduced to zero the clinic has made the follow changes to minimize risk and keep everyone's health a top priority.

Therapists have completed Infection Prevention and Control training, including hand hygiene and PPE instruction.

COVID-19 screening will be completed at the time of scheduling your appointment. You will be re screened upon arrival of your appointment.

Therapist will self-screen for COVID-19 at the beginning of every shift.

Results of client and therapist tests will be documented.

The clinic will be utilizing enhanced cleaning and disinfecting products that are approved by Health Canada. All procedures will be documented in Infection Prevention and Control Log.

The office appearance has been altered as all non-essential items have been removed as well as most non-essential absorbent materials.

Touchless items such as garbage cans with foot pedals are now available.

Therapist will wash hands/forearms and elbows after each treatment followed by hand sanitization.

Client must wait in their vehicle until notified by therapist that clinic has been cleaned and disinfected and ready for your arrival. Clinic door will be open for direct entry into clinic to avoid waiting in common areas.

Chairs in waiting area have been reduced for social distancing purposes.

Due to increased cleaning and disinfecting measures therapist must be time conscious and stick to a strict schedule. Late arrivals will affect the duration of treatment you receive.

Client will be instructed to sanitize hands pre and post treatment. Hand sanitizer approved by Health Canada will be available. Postings on proper hand sanitization procedures are posted.

Client must wear mask or face covering to enter facility and Massage Therapy Clinic.

Therapist will wear mask, gown, gloves and eye protection.

Social distancing of 2 meters has been marked in office area. It is unachievable to maintain social distancing for consultation/ assessments and treatments.

Clients are encouraged to arrive for your appointments unaccompanied unless assistance is required. Additional party must also comply with COVID-19 screening. Please notify clinic if you require accompaniment for your appointment.

Contact Tracing Log will be maintained to record names and contact information of all individuals that enter clinic.

All linens and blankets will be cleaned between each client. Vinyl pillows have been purchased for disinfecting purposes.

The clinic appreciates your patience and understanding at this time as we all navigate this 'new normal'.