Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), Functional Fitness and Physical Therapy is taking extra precautions with the care of every client to include health history review and enhanced sanitation/disinfection procedures in accordance with the Commonwealth of Massachusetts and Town of Easton guidance.
Symptoms of COVID-19 include:
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 Functional Fitness and Physical Therapy, LLC and my Physical Therapist 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.
Functional Fitness and Physical Therapy is following these enhanced procedures to prevent the spread of COVID-19:
Additional time included between appointments to prevent client contact with each other
Guests accompanying those scheduled for services discouraged
Each client required to sanitize or wash hands upon arrival and before leaving
Your Physical Therapist will thoroughly clean hands before and after each session
Your Physical Therapist will wear a face mask during each session
All surfaces will be wiped thoroughly with hospital grade disinfectant before and after each client according to the manufacturer's directions
By signing below, I agree to each statement above and release Functional Fitness and Physical Therapy, LLC and my Physical Therapist from any and all liability for the unintentional exposure or harm due to COVID-19.