I give my consent to receive bodywork and agree to the following provisions and conditions stated below:
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities may still recommend practicing social distancing. I further acknowledge that Courtney Berry, LMT and Jordon Berry, LMT of Myo Partners, LLC (hereinafter, “Practitioners”) have put in place preventative measures to reduce the spread of the Coronavirus/Covid-19, that I will may be in close contact with my Practitioner(s) and/or office staff and/or other clients, and that it is impossible for Practitioners to guarantee that I will not become infected with the Coronavirus/Covid-19. By signing this form, I acknowledge that I am aware of the risks involved, indemnify and hold harmless Practitioners, Myo Partners, LLC and their associates, and give consent to receive bodywork from Practitioners.
I attest that:
(1) I am not experiencing any symptom 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,
(2) I do not believe I have been exposed to someone with a suspected and/or confirmed case of the COVID-19,
(3) I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities,
(4) I will notify Practitioners prior to any future appointments if any of these items are not true now or at any time in the future.