To proceed with receiving care, I confirm and understand the following:

I understand that the novel Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). I further understand that COVID-19 is extremely contagious and may be contracted from various sources. I understand COVID-19 has a long incubation period during which carriers of the virus may not show symptoms and still be contagious.

I understand that I am the decision-maker for my health care. To the best of their ability, Your Muscle Whisper, Get Out Of Shape LLC and my practitioner will provide me with information to assist me in making informed choices. This process is often referred to as “informed consent” and involves my understanding and agreement regarding recommended care, and the benefits and risks associated with the provision of health care during a pandemic. Given the current limitations of COVID-19 virus testing, I understand determining who is infected with COVID-19 is exceptionally difficult.

I understand that preventative measures and intensified sanitation protocols intended to reduce the spread of COVID-19 have been implemented by Your Muscle Whisper, Get Out Of Shape LLC. However, because this work involves close physical proximity over an extended period of time in a closed space, there may be an elevated risk of disease transmission, including COVID-19. Despite Your Muscle Whisper, Get Out Of Shape LLC reasonable efforts, Your Muscle Whisper, Get Out Of Shape LLC cannot guarantee that I will not become infected with COVID-19. I hereby acknowledge and assume the risk of becoming infected with COVID-19 through this treatment and give my express permission to Your Muscle Whisper, Get Out Of Shape LLC, you, and the staff at your offices to proceed with providing care.

ASSUMPTION OF RISK: I acknowledge the contagious nature of COVID-19 and voluntarily assume that I may be exposed to or infected by COVID-19 by attending sessions at Your Muscle Whisper, Get Out Of Shape LLC and that such exposure may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed or infected by COVID-19 at Your Muscle Whisper, Get Out Of Shape LLC may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Your Muscle Whisper, Get Out Of Shape LLC sole practitioner, and, clients.

WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against Your Muscle Whisper, Get Out Of Shape LLC and its owners, officials, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing Your Muscle Whisper, Get Out Of Shape LLC sessions and or premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.

CHOICE OF LAW: I understand and agree that the law of the State of Maryland will apply to this contract.

I have saved an electronic copy, or have been offered a link to access this consent form online.

I KNOWINGLY AND WILLINGLY CONSENT TO THE TREATMENT WITH THE FULL UNDERSTANDING AND DISCLOSURE OF THE RISKS ASSOCIATED WITH RECEIVING CARE DURING THE COVID-19 PANDEMIC. I CONFIRM ALL OF MY QUESTIONS WERE ANSWERED TO MY SATISFACTION. I HAVE READ, OR HAVE HAD READ TO ME, THE ABOVE COVID-19 RISK-INFORMED CONSENT TO TREAT. I APPRECIATE THAT IT IS NOT POSSIBLE TO CONSIDER EVERY POSSIBLE COMPLICATION TO CARE. I HAVE ALSO HAD AN OPPORTUNITY TO ASK QUESTIONS ABOUT ITS CONTENT, AND BY SIGNING BELOW, I AGREE WITH THE CURRENT OR FUTURE RECOMMENDATION TO RECEIVE CARE AS IS DEEMED APPROPRIATE FOR MY CIRCUMSTANCE. I INTEND THIS CONSENT TO COVER THE ENTIRE COURSE OF CARE FROM ALL PROVIDERS IN THIS OFFICE FOR MY PRESENT CONDITION AND FOR ANY FUTURE CONDITION(S) FOR WHICH I SEEK CARE FROM THIS OFFICE.

COVID Office Policies

AT HOME - SELF-HEALTH SCREEN

• I will take my body temperature at home before I leave for my appointment.

• I will check to see if I have a fever over 99.5 degrees

• I will see if I have any respiratory or flu symptoms, sore throat, or shortness of breath

• I see if I have recently had, chills, muscle aches, new loss of taste or smell, or new rashes or lesions.

• I will see if I have had contact with anyone in 14 days who has been diagnosed with COVID-19

SHOULD I ATTEND MY SESSION?

• Cleared - If you didn't check any of the self-health questions above and your temperature is below 99.5 degrees F please proceed to my office

• Not Cleared – If you checked any of the self-health questions above and your temperature is at or above 99.5 degrees F please contact me and we can discuss this to see if we need to reschedule. (410) 703-6956 info@YourMuscleWhsiperer.com

MASKS ARE REQUIRED

• Proper COVID masks are required the whole time you are in the office and treatment room.

• A well-fitting mask is one that is form-fitting and covers both your mouth and nose.

• If you do not have a mask to wear I can supply you with one. Just text me and I can bring one to you at the door.

• There are no exceptions. If you do not want to wear a mask you can re-schedule your in-person appointment or schedule an online session. Thank you for your understanding.