COVID-19 Risk Informed Consent
I understand that I am opting for an elective
treatment/procedure/surgery that is not urgent and may not be medically necessary.
I also understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the
World Health Organization. I further understand that COVID-19 is extremely contagious and is believed to
spread by person-to-person contact; and, as a result, federal and state health agencies recommend social
distancing. I recognize that Michelle Hoff and all the staff at Timeless Beauty Aesthetics are closely monitoring this situation and have put in place reasonable
preventative measures aimed to reduce the spread of COVID-19. However, given the nature of the virus, I
understand there is an inherent risk of becoming infected with COVID-19 by virtue of proceeding with this
elective treatment/procedure/surgery. I hereby acknowledge and assume the risk of becoming infected with
COVID-19 through this elective treatment/procedure/surgery, and I give my express permission for Michelle Hoff and all the staff at Timeless Beauty Aesthetics to proceed with the same.
I understand that, even if I have been tested for COVID and received a negative test result, the tests in some
cases may fail to detect the virus or I may have contracted COVID after the test. I understand that, if I have a
COVID-19 infection, and even if I do not have any symptoms for the same, proceeding with this elective
treatment/procedure/surgery can lead to a higher chance of complication and death.
I understand that possible exposure to COVID-19 before/during/after my treatment/procedure/surgery may
result in the following: a positive COVID-19 diagnosis, extended quarantine/self-isolation, additional tests,
hospitalization that may require medical therapy, Intensive Care treatment, possible need for
intubation/ventilator support, short-term or long-term intubation, other potential complications, and the risk of
death. In addition, after my elective treatment/procedure/surgery, I may need additional care that may require
me to go to an emergency room or a hospital.
I understand that COVID-19 may cause additional risks, some or many of which may not currently be known at
this time, in addition to the risks described herein, as well as those risks for the treatment/procedure/surgery
I have been given the option to defer my treatment/procedure/surgery to a later date. However, I understand
all the potential risks, including but not limited to the potential short-term and long-term complications related to
COVID-19, and I would like to proceed with my desired treatment/procedure/surgery.