I attest that:

• I am not experiencing any unexplained symptom of illness such as cough, fever or chills, shortness of breath, difficulty breathing, sore throat, congestion, runny nose, fatigue, new loss of taste or smell, body aches, nausea, or vomiting.
  
  
• I have not traveled to a highly COVID-19 impacted area in the last 14 days.
  
  
• I do not believe I have been exposed to someone with a suspected and/or confirmed case of COVID-19.
  
  
• I have not been diagnosed with COVID-19 and not declared as non-contagious by state or local public health authorities.
  
  
• I am following all CDC recommended guidelines as much as possible and limiting my exposure to COVID-19.

I understand that close contact with people increases the risk of infection from COVID-19. 

I acknowledge that Holistic Massage of Hood River LLC cannot guarantee that I will not become infected with COVID-19. 

I understand that the risk of becoming exposed to and/or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to staff, and other clients and their families. 

I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment. 

I understand that my name and contact information might be shared with the state health department in the event that a client or practitioner at Holistic Massage of Hood River LLC tests positive for COVID-19. My contact details will only be shared in the event they are relevant based on suspected exposure date, and only for appropriate follow-up by the health department.

I hereby release and agree to hold Holistic Massage of Hood River LLC harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the clinic, or that may otherwise arise in any way in connection with any services received from Holistic Massage of Hood River LLC. I understand that this release discharges Holistic Massage of Hood River LLC from any liability or claim that I, my heirs, or any personal representatives may have against the clinic with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Holistic Massage of Hood River LLC. This liability waiver and release extends to the clinic together with all owners, partners, and employees.

By signing this form I confirm all attestations contained herein apply to me and acknowledge that I am aware of the risks involved and give consent to receive massage from the practitioners at Holistic Massage of Hood River LLC.