Laser COVID-19 Liability Release Form

Healing Grace Massage is taking all neccessary precautions to limit the spread of COVID-19. Included is a health history review of the client and sanitation/disinfectant procedures in accordance with the Michigan LARA Regulations.

Symptoms of COVID-19:

Fever
Cough
Shortness of Breath
Sore Throat
Chills
Headache
New loss of taste or smell

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 traveled out of the country or to any city in the United States considered a "hotspot" for COVID-19 WITHIN THE PAST 14 DAYS. I affirm that I, as well as all household members, have not been diagnosed with COVID-19 WITHIN THE PAST 14 DAYS. I understand that I am required to wear a mask upon entering Healing Grace Massage, and I am required to wear a mask at all times within Healing Grace Massage. If I fail to wear a mask, I will be asked to leave and the appointment will be fully charged. If I am unable to wear a mask due to a health condition, then the appointment will need to be rescheduled. Face masks are available for $1 if I need, or I can wear my own face mask. I understand that Healing Grace Massage requires a 24 hour notice in the event that I may need to cancel, reschedule, or change my appointment. If I do not cancel, or reschedule my appointment within 24 hours, the appointment will be 100% charged.

Healing Grace Massage has developed new procedures to help against spreading COVID-19. All procedures and changes will be updated on the website: www.healinggracetherapy.com

Online scheduling is temporarily unavailable until further notice.

Every client is required to wear a mask.

Contactless temperature checks will be taken and logged when you arrive.

Please remove shoes by the front door. There will be NO shoes allowed inside the treatment room.

Before your appointment, please wash your hands with soap and water or use hand sanitizer.

Please sanitize your hands before leaving the treatment room.

Anyone accompanying a scheduled client may not wait within the waiting room, unless the client is a minor.

There will be additional time in between each appointment to allow for enhanced sanitation.

All payment methods are still being accepted (cash, check, debit/credit card).

No beverages or magazines will be available. Clients may bring in their own covered beverage.

HEPA air purifiers will be available within the treatment room.

I will provide a clean face mask and a face sheild during your appointment.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by my mere presence within this establishment and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, employees, volunteers, and program participants and their families. I hereby release Healing Grace, LLC, from any and all claims arising from or in connection with any direct COVID-19 impact while visiting.

Date *

Date

Name

First Name Last Name

Signature *

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