I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the
CDC and many other public health authorities still recommend practicing social distancing.
I further acknowledge that Healing Melodies MTME, LLC has put in place
preventative measures to reduce the spread of the Coronavirus/COVID-19.
I further acknowledge that Healing Melodies MTME, LLC cannot guarantee that I
will not become infected with the Coronavirus/Covid-19. I understand that the
risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may
result from the actions, omissions, or negligence of others, and myself including,
but not limited to, Healing Melodies MTME Staff and other Healing Melodies
MTME clients and their families.
I voluntarily seek services provided by Healing Melodies MTME, LLC and
acknowledge that I am increasing my risk to exposure to the
Coronavirus/COVID-19. I acknowledge that I must comply with all set
procedures to reduce the spread while attending my appointment.
I attest that:
* I am not experiencing any symptom of illness such as cough, shortness of breath
or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain,
headache, sore throat, or new loss of taste or smell.
* I have not traveled internationally within the last 14 days.
* I have not traveled to a highly impacted area within the United States of
America in the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or
confirmed case of the Coronavirus/COVID-19.
* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as
non-contagious by state or local public health authorities.
* I am following all CDC recommended guidelines as much as possible and
limiting my exposure to the Coronavirus/COVID-19.
I hereby release and agree to hold Healing Melodies MTME, LLC harmless from,
and waive on behalf of myself, my heirs, and any personal representatives any
and all causes of action, claims, demands, damages, costs, expenses and
compensation for damage or loss to myself and/or property that may be caused by
any act, or failure to act of the Company, or that may otherwise arise in any way
in connection with any services received from Healing Melodies MTME, LLC. I
understand that this release discharges Healing Melodies MTMELLC from any
liability or claim that I, my heirs, or any personal representatives may have
against the company with respect to any bodily injury, illness, death, medical
treatment, or property damage that may arise from, or in connection to, any
services received from Healing Melodies MTME, LLC. This liability waiver and
release extends to the Company together with all owners, partners, and

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