Due to the 2019-2020 outbreak of the Coronavirus (COVID-19), Premier Therapeutics, LLC is taking extra precautions with the care of every client to include health history review and enhanced sanitation/disinfecting procedures in compliance with CDC, state, and LABMT guidance. 

 

Symptoms of COVID-19 include but are not limited to: 

• Fever

• Fatigue

• Dry Cough

• Difficulty Breathing

 

 

I agree to the following:

• I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.

• I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 30 days.

• I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days.

• I affirm that I, as well as all household members, have not traveled outside of the country or to any city considered to be a “hot spot” for COVID-19 infections within the past 30-days.

• I understand that Premier Therapeutics, LLC cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.

 

 

Our business is following theses enhanced procedures to prevent the spread of COVID-19:

• Protective masks (optional)

• Sanitizing before and after each session

• Hand washing

• Limiting number of clients in office

• Limiting number of sessions per day

 

 

I agree to each statement above and release Premier Therapeutics, LLC, its affiliates, contractors, employees, etc. from any and all liability for unintentional exposure or harm due to COVID-19.

​

For more information visit:

​

https://www.labmt.org/site.php

or

https://gov.louisiana.gov/coronavirus/

​

​

Thank you for understanding and your cooperation.