Additionally, I acknowledge the contagious nature of the Coronavirus/COVID-19 and that many public health authorities currently recommend practicing social distancing.
I further acknowledge that Sandra Galiwango (“Sandra Rose”) has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I further acknowledge that Sandra Galiwango cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to Sandra Galiwango, other practioners sharing the space, and/or other clients and their families.
I voluntarily seek services provided by Sandra Galiwango and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with attestations below to reduce the spread while attending my appointment.
I attest that:
* I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I have not traveled internationally within the last 14 days.
* I have not traveled to a highly impacted area within the United States of America in 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 have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities.
* I am following public health recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
* To reduce the likelihood of spread, if I have any reason for doubt, I am encouraged to voluntarily (honor system) get tested prior to my appointment.
I hereby release and agree to hold Sandra Galiwango harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act by Sandra, other clients, or that may otherwise arise in any way in connection with any services received from Sandra Galiwango. I understand that this release discharges Sandra Galiwango from any liability or claim that I, my heirs, or any personal representatives may have against her with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Sandra Galiwango.