Covid Vaccination Proof Page for Visitors

Please, read next document carefully.

COVID-19 Liability Release Waiver

**Signature Required During Check-in**

Due to the outbreak of the novel Coronavirus (COVID-19), Moshes Law, PC is doing everything we can to protect you, our clients, our community and our staff. To this extent, Moshes Law, PC will be following the Center of Disease-Control (CDC) with regard to social distancing practices and sanitation. We ask that our clients disclose their health history and continue to implement these sanitation and disinfection procedures.

Symptoms of COVID-19 include:

• Fever
• Fatigue
• Dry Cough
• Difficulty Breathing

I agree to the following:

• I, nor members of my household, have not experienced any of the symptoms listed above within the last 14 days.
• I, nor members of my household, have not travelled internationally in the last 30 days.
• I, nor members of my household, have not traveled to a highly impacted area within the United States of America is the last 30 days.
• I, nor members of my household, do not believe that we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus (COVID-19).
• I, nor members of my household, have not been diagnosed with the Coronavirus (COVID-19) within the last 30 days.
• Moshes Law, PC cannot be held liable from any exposure to the Coronavirus (COVID-19) caused by misinformation on this form or the health history provided by each client.
• If I take any steps to make a claim for damages against Moshes Law, PC, its agents, employees or any other released parties, I shall be obligated to pay all attorney’s fees and costs incurred as a result of such claim

Moshes Law, PC is following these enhanced procedures to prevent the spread of the Coronavirus (COVID-19)

• All clients must wear a surgical mask during the duration of the service or service will be denied
• A maximum of 5 customers will be allowed in the waiting room
• We discourage guests accompanying scheduled customers
• Additional time will be scheduled in between client appointments to limit client contact. 
• Each client is required to wash their hands upon arrival and before departure.
• All surfaces will be thoroughly cleaned with hospital grade disinfectant before and after each client, according to the manufacturer’s directions.

By signing below, I hereby release and agree to hold Moshes Law, PC 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 damages 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 Moshes Law, PC. I agree to release Moshes Law, PC from any and all liability for the unintentional exposure or harm due to the Coronavirus (COVID-19)

Moshes Law, PC agrees to abide by these standards and affirms the same.

Date: 09-21-2023