Gateway Medspa COVID-19 Risk Consent Form
I understand that the novel coronavirus causes the disease known as COVID-19. I understand that the coronavirus has a long incubation period during which the carriers of the virus may not show the symptoms and may still be contagious.
I also understand that COVID-19 has been declared a worldwide pandemic by the World Health Organization and that it is extremely contagious. I understand that it is believed to be spread by person-to-person contact, and, as a result, federal and state health agencies recommend social distancing.
I understand that the physical distancing of 6 feet may not be possible while receiving services.
I understand that Gateway Medspa has put in place reasonable preventive measures aimed to reduce the spread of COVID-19. However, given the nature of the virus, I understand that there is an inherent risk of becoming infected with COVID-19 by virtue of proceeding with this elective treatment/procedure. I hereby acknowledge and assume the risk of becoming infected with COVID-19 through this elective treatment / procedure and give my express permission for Dr. Fortunata Mendoza and all the staff of Geteway Medspa to proceed with the same.
I understand that Dr. Fortunata Mendoza and all the staff of Gateway Medspa will do everything possible to minimize the spread of COVID-19 and will not hold them responsible should I contract the COVID-19.
I have been given the option to defer my treatment/ procedure to a later date. However, I understand all the potential risks, including but not limited to the potential short-term and long-term complications related to COVID-19 and would like to proceed with my desired treatment/procedure.
I UNDERSTAND THE EXPLANATION AND HAVE NO MORE QUESTIONS. I CONSENT TO THE PROCEDURE.