I knowingly and willingly consent to today’s visit and 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.
By signing this form I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected COVID-19 by my mere presence within the establishment and such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that th 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 McLean Dermatology and Skincare Center, LLC and Skinkure, LLC from any and all claims arising from or in connecting with any direct COVID-19 impact while visiting.