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  • COVID-19 Liability Release Waiver

  • I understand that the novel Coronavirus (COVID-19) has been declared a global pandemic. 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. Part of this practice and team of health providers’ role is to 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 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.

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