Consent for Services
Unprecedented actions are being taken across the country to reduce the spread of COVLD-19, a virus that spreads easily from close contact. The American Physical Therapy Association encourages clinicians to use their professional judgement to determine when, where, and how to provide care, with the understanding that this Is not the optimal environment for care.
At US Service Center, we are following CDC guidance to minimize exposure within our organization and at our client’s job sites. All people must also take responsibility to protect themselves and others by taking the following precautions:
- Stay home with symptoms of fever, cough, difficulty breathing, or sore throat
- Wash hands before entering and leaving
- Use a face covering
- Practice social distancing, remaining 6 feet away from other people
While US Service Center has put In place preventative measures to reduce the spread of COVID-19, US Service Center cannot guarantee that you will not become Infected with COV1D-19. Further, engaging in services with US Service Center could increase your risk of contracting COVID-19, because you will not be at home, and you will be in contact with US Service Center staff and possibly other staff of US Service Center.
By agreeing to our terms and conditions, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 and that such exposure or infection may result in serious illness or death. I understand that the risk of becoming exposed to or infected by COVID-19 at US Service Center and/or when US Service Center staff work at my location(s). I understand that by not following US Service Center preventive measures I may subject others to greater risk for COVID-19.
I hereby release, covenant not to sue, discharge, and hold harmless US Service Center, its employees, agents, and representatives (“Released Parties), of and from any claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to infection with COVID-19.
In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment I am aware and understand that I should carry my own health Insurance.
By agreeing to our terms and conditions,, I acknowledge and represent that I have read the foregoing Assumption of Risk and Waiver of Liability, understand it and agree to it voluntarily. I am sufficiently informed about the risks involved to decide whether to agree to this Consent, and no oral representations, statements, or inducements, apart from the Consent, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this document for full, adequate, and complete consideration fully intending to be bound by the same. I agree that this Consent shall be governed by and construed in accordance with California law, and that if any of the provisions hereof are found to be unenforceable, the remainder shall be enforced as fully as possible and the unenforceable provision(s) shall be deemed modified to the extent required to permit enforcement of the Assumption of Risk and Wavier of Liability as a whole.
Last updated 06/17/2020