I understand that I am opting for a service that is not urgent and not medically necessary.
I also understand that the coronavirus disease (COVID-19) has been declared a worldwide pandemic by the World Health Organization. I further understand COVID-19 is extremely contagious. State and federal health agencies recommend social distancing.
I recognize that the staff at are closely monitoring this situation and have put in place reasonable preventive measures targeted to reduce the spread of this virus. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 if I proceed with this elective service.
Accordingly I acknowledge and assume the risk of becoming infected with COVID-19, and any variation or mutation thereof, through this elective service and I gave my express permission for the staff at to proceed with the same. This consent applies to any follow up or additional services in the upcoming months.
I understand that even if I have been tested for COVID-19 and received a negative test result, the tests may not have detected the virus or I may have contracted COVID-19 after the test. I will not hold this business and professional offering the service responsible for any liability related to COVID-19 and any variation or mutation thereof.
I understand that exposure to COVID-19 before, during, or after my procedure(s) may result in complications and/or delayed healing.
I have been given the option to defer my service to a later date. However, I understand all the risks including those noted herein and I would like to proceed with this service. I can ask to have a copy of this consent form emailed to me and have access to this consent form at jessicadevereux.com.
I understand the explanation and consent to the procedure. By submitting my name typed name below, I understand the explanation and consent to the procedure.
I also understand that the coronavirus disease (COVID-19) has been declared a worldwide pandemic by the World Health Organization. I further understand COVID-19 is extremely contagious. State and federal health agencies recommend social distancing.
I recognize that the staff at are closely monitoring this situation and have put in place reasonable preventive measures targeted to reduce the spread of this virus. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 if I proceed with this elective service.
Accordingly I acknowledge and assume the risk of becoming infected with COVID-19, and any variation or mutation thereof, through this elective service and I gave my express permission for the staff at to proceed with the same. This consent applies to any follow up or additional services in the upcoming months.
I understand that even if I have been tested for COVID-19 and received a negative test result, the tests may not have detected the virus or I may have contracted COVID-19 after the test. I will not hold this business and professional offering the service responsible for any liability related to COVID-19 and any variation or mutation thereof.
I understand that exposure to COVID-19 before, during, or after my procedure(s) may result in complications and/or delayed healing.
I have been given the option to defer my service to a later date. However, I understand all the risks including those noted herein and I would like to proceed with this service. I can ask to have a copy of this consent form emailed to me and have access to this consent form at jessicadevereux.com.
I understand the explanation and consent to the procedure. By submitting my name typed name below, I understand the explanation and consent to the procedure.
