I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.

I voluntarily seek services provided by Jen Obst and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19.

I acknowledge that I must wear a mask to reduce the spread while attending my appointment.

I attest that:
* I am not experiencing any symptoms such as cough, shortness of breath or difficulty breathing, fever, chills, muscle pain, headache, sore throat, or new loss of taste or smell.

* I have not traveled internationally within the last 14 days.

* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.

* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

 I understand that this release discharges Jen Obst from any liability or claim that I may have, with respect to illness, death or medical treatment that may arise from any services received from Jen Obst.