COVID-19 Pandemic Reiki Treatment or Training Consent Form

Please take a moment to complete this consent form.

By submitting the form below you agree to knowingly and willingly consenting to services provided by Attune: The Art of Reiki during the COVID-19 pandemic.

We reserve the right to refuse service if this form is not submitted. Thank you.

Covid 19 Consent Form

General Health Questions: 1. Have you traveled internationally over the last 14 days?

2. Have you had close contact* with or cared for someone diagnosed with Covid-19, someone who is suspected of having COVID-19, or someone who has been directed to self-isolate or self-quarantine due to COVID-19 within the past 14 days? (Excluding Medical Professionals)

Have you been diagnosed with Covid-19, are you suspected of having COVID-19, have you been directed to self-isolate or self-quarantine due to COVID-19, or have you experienced any cold or flu-like symptoms in the last 14 days? (Fever, cough, sore throat, respiratory illness, difficulty breathing, chills, repeated shaking, muscle pain, headache, or new loss of taste and/or smell)

I confirm that I have not been around anyone with these symptoms in the past 14 days. *

I hereby acknowledge that I have read and understand the above questions and answered them truthfully. While Attune: The Art of Reiki, LLC has taken precautions to prevent the spread of COVID-19, I understand the risks of contracting COVID-19 from today’s services and the risk of community transmission, and I consent to today’s services and assume the risks. Release of All Claims Form: The undersigned, being of lawful age, does hereby forever release and discharge Attune: The Art of Reiki, LLC its employees, agents, representatives, owners, directors, officers, successors, predecessors, divisions, subsidiaries, affiliates, assigns, insurers, and all person acting by, though, under, or in concert with any of them from any and all liability, claims, actions,complaints, obligations, promises, agreements, controversies, demands, damages, losses, debts, expenses (including attorneys’ fees) and causes of action, of any kind, including but not limited to personal injuries, negligence actions, medical expenses, pain and suffering, lost wages and all other damages, whether now known or unknown, resulting from the rendering of service’s at Attune: The Art of Reiki,LLC. The undersigned agrees that he/she has received adequate and fair consideration in exchange for signing this agreement.

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