COVID-19 Liability Release Waiver for Clients 

 

Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), I am taking extra precautions with the care of every client to include health history review and enhanced sanitation/disinfecting procedures in compliance with CDC guidance. 

Symptoms of COVID-19 include:

 • Fever • Fatigue • Dry Cough • Difficulty Breathing 

I agree to the following: 

• 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 past 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 past 30 days. 

• I affirm that I, as well as all household members, have not traveled outside of the country or to any city considered to be a “hot spot” for COVID-19 infections within the past 30-days. 

• I understand that Balanced Lotus Wellness cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client. 

 

I am following these enhanced procedures to prevent the spread of COVID-19: 

• Requiring masks be worn by both parties at ALL TIMES while in session

• Requiring hand sanitization of myself and the client upon entrance and departure of the session

• As usual, washing the table used and any blankets/sheets/pillows used after EACH session

• As usual, leaving the option for hands-off treatment Sanitizing all surfaces commonly touched by myself & the client upon departure (doorknobs, handles, coat racks, etc)

 

By signing below, I acknowledge & agree to each statement above and release Alexa Lizotte of Balanced Lotus Wellness from any and all liability for unintentional exposure or harm due to COVID-19.