COVID-19 Informed Consent Agreement
I am aware that exposure to COVID-19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death.
I understand in-person services increase the risk of my transmission of COVID-19 to my Service Provider and staff. This virus has a long incubation period, there may be as yet unknown aspects of its transmission, and I realize that I may be contagious, whether or not I have been tested or have symptoms.
To reduce the possibility of COVID-19 exposure or transmission at Bare Essentials, I accept that my Service Provider will implement infection-control procedures with which I must comply with during my service, for my own protection as well as that of my Service Provider.
I understand my cooperation is mandatory, whether or not I personally feel such COVID-19 procedures and/or preventive measures are necessary.
I confirm neither I nor any individual living with me has any of the COVID-19 symptoms listed by the Ontario Ministry of Health. Neither I nor any individual living with me during the past 14 days has experienced any such symptoms.
I accept the risk of COVID-19 exposure and I will bear the cost of any COVID-19 treatments required. I have been given the opportunity to postpone my appointment until the COVID-19 pandemic is less prevalent, but I choose to have my in-person service performed now.
I have read this COVID-19 Informed Consent Agreement and am authorized to consent on my behalf.
October 24, 2020