Precautionary Coronavirus Liability Release Form

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Due to the 2019 - 2020 outbreak of the Coronavirus, COVID-19, we are taking extra precautions with the intake of each client, health history review as well as sanitation and disinfecting practices. Please complete the following and sign below. Symptoms of COVID-19 include: Fever, Fatigue, dry cough and/or difficulty breathing. *

I understand the above symptoms and affirm that I, as well as all household members do not currently have, nor have experienced the symptoms listed above within the last 14 days.

I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the last 30 days.

I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days.

I affirm that I, as well as all household members, have not traveled outside the country , or to any city outside of our own that is or has been considered a "hot spot" for COVID-19 infections within the last 30 days.

I understand that the 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 or health history provided by each client.

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By signing below I agree to each above statement and release the massage therapist and business from any and all liability for the unintentional exposure or harm due to the COVID-19. Your massage therapist and all employees of this facility agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions. PRINT FULL NAME BELOW AS YOUR DIGITAL SIGNATURE. *

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