Precautionary Coronavirus Liability Release Form

Precautionary Coronavirus Liability Release Form
Due to the 2019 to 2020 COVID-19 outbreak, we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete and sign the following below.

Symptoms of COVID-19 include but are not limited to:
- Fever
- Fatigue
- Dry Cough
- Difficulty breathing
- Loss of taste or smell
I,
Name

First NameLast Name
agree to the following:
I understand and affirm that I, nor any members of my household do not currently have or have experienced any of the following symptoms within the last 14 days.
I affirmed that I, as well as all members of my household have not been diagnosed with COVID-19 within the last 30 days.
I affirm that I, as well as all members of my household have not knowingly been in contact with anyone who has been diagnosed with COVID-19 within the last 30 days.
I affirm that I, as well as all members of my household have not traveled outside of the country, and have not traveled to any city that may be considered a “hotspot” for COVID-19 infections within the last 30 days.
I understand that this business and my massage therapist cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form and the health history form provided by each client.
By signing below agree to each above statement and reles de my massage therapist and the business from any and all liability for the unintentional exposure or harm due to COVID-19.

Your massage therapist and all employees of this establishment agree that they will abide by the standards and affirm the same. We also affirm that we have improved an expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.
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