Below is a digital view of the waiver to be signed by the client before entering the session. A physical copy will be provided to you upon arrival. If you do not wish to oblige by the conditions of the waiver, please do not book an appointment at this time. Thank you for your understanding and cooperation.

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.

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