COVID-19 Consent Form

Mississauga (ORC) 905.822.1823

Oakville 905.337.2122

I hereby acknowledge that the above answers are true to the best of my knowledge. I acknowledge and accept that there is a risk that I could be exposed to COVID-19 while attending Club Physio Plus. I also acknowledge and accept that while receiving services, the therapist may need to be closer than the recommended social distancing guidelines in order to assess and/or treat me. I acknowledge and confirm that I am willing to accept this risk as a condition of attending at Club Physio Plus to receive services from the therapist. In consideration of the therapist agreeing to see me in person at Club Physio Plus, I agree to release the therapist and Club Physio Plus (if applicable), their officers, directors, employees, agents and volunteers (the “Releasees”) from any and all causes of action, claims, demands, requests, damages or any recourse whatsoever in respect of any personal injuries or other damages which may occur or arise as a result of exposure to COVID-19 during my visit to Club Physio Plus and/or through the provision of services to me by the therapist. I do hereby acknowledge and agree that notwithstanding the generality of the foregoing, I declare that I will not commence litigation or otherwise seek to recover damages or other compensation against the Releasees based on any action, claim, demand, request, loss or any recourse whatsoever arising from any potential or actual exposure to COVID-19 while attending at Club Physio Plus and/or through the provision of services to me by the therapist. I further acknowledge that the Releasees can rely on this Release of Liability, Waiver of all Possible Claims and Assumption of Risk as a complete defence to any and all claims, damages, causes of action, or recourse or liability that may arise at any time. I have carefully reviewed this Release of Liability, Waiver of all Possible Claims and Assumption of Risk and acknowledge that I fully understand the terms as set out above. I acknowledge that I am signing this Release of Liability, Waiver of all Possible Claims and Assumption of Risk voluntarily.

Please submit the completed consent to the appropriate clinic prior to your appointment:
PLEASE CLICK THE BOX AND PICK THE CLINIC LOCATION YOU ARE ATTENDING

LET’S GET SOCIAL

CLUB PHYSIO PLUS COVID-19 CONSENT FORM