Genki Clinic - Covid-19 Consent

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Thanks in advance for your help: We can only treat you if you have completed this form before each treatment.

COVID-19 Risk *

I understand that COVID-19, is extremely contagious and is spread by person-to-person contact; and, as a result, social distancing is recommended. This is not possible with my proposed treatment. However, I am satisfied that safety measures are in place to minimise risk as much as possible.

Required

Treatment Permission *

I understand that, because my treatment will involve touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including Covid-19. I understand all the potential risks, including but not limited to the potential short-term and long-term complications related to COVID-19, and I would like to proceed with treatment.

Required

Wellness Declaration *

I confirm that I am not currently testing positive for Covid-19 and have no reason to suspect that I may be positive.

Required

First Name *

Surname *

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