I understand that I am opting for an elective treatment/procedure of which Is not medically necessary.
I understand that the Coronavirus, COVID-19 has been declared a worldwide pandemic by the world health organisation and that COVID-19 is extremely contagious and is believed to be spread by person-to-person contact. As a result, social distancing is recommended. This is not entirely possible with my proposed treatment; however, I am satisfied that safety measures are in place to minimise risk as much as possible, and patient/client contact will be kept to an absolute minimum in line with the medical/treatment need.
I understand the management and clinical staff are closely monitoring the COVID-19 Situation and have put in place reasonable preventative measures aimed to reduce the spread of COVID-19. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 by virtue of proceeding with treatment. I hereby acknowledge and assume the risk of becoming infected by COVID-19 through this elective treatment/procedure and give my express permission to proceed.
I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. I understand that COVID-19 may cause additional health risks, some of which may not be currently known at this time, in addition to those risks associated with a medical treatment/procedure itself.
I have been given the option to defer my treatment/procedure to a later date, however, I understand all the potential risks, including but not limited to the potential short term and long erm complications related to COVID-19 and I would like to proceed with my desired treatment/procedure.
I confirm that I am not presenting with any of the following symptoms of COVID-19 listed below:
o Fever
o Shortness of breath
o Loss of sense of taste or smell
o Dry couch
o Runny nose
o Sore throat
I understand that the air travel considerably increases my risk of contracting and transmitting the COVID-19 virus, I confirm that I have not travelled in the last 14 days.
I confirm that if I develop COVID-19 symptoms following my treatment/procedure or a known contract of mine develops symptoms, I will immediately inform the Micropigmentation clinic to enable appropriate measure to be put in place and contact tracing to commence.
I confirm that I understand to leave two weeks either side of my Covid19 vaccination. Ie two weeks before or two weeks post vaccination.
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