COVID-19 Liability Waiver & Clinic Protocol​

This form must be completed prior to any service at Zen Den Medical.  Please complete the form below and sign, acknowledging your understanding of our business policies and protocols to ensure your safety.

  • Please sign and submit prior to your visit to Zen Den Medical

  • Acknowledgement of Business Policies

  • We ask for a minimum of 24 hours advance notice to cancel your appointment or class at Zen Den Medical to allow us to offer your time to another client. We reserve the right to charge for your missed class or appointment in full.
  • Fees collected for classes and appointments are non-refundable. Zen Den Medical will however right any situation or circumstance outside of our cancellation policy with a gift card.

  • Acknowledgement of Clinic PPE Protocol

  • 1. Wear a mask when you enter the building

    2. Please arrive no earlier than 5 minutes prior to your appointment and wait in the lobby for a clinician to greet you and take your temperature. If your temperature is 100 degrees or higher you will not be admitted.

    3. Limit touching of services as you navigate the building.

    4. Clinicians will be wearing masks.

    5. Only the clinician treating you will be within 6 feet of you when hands on therapy is required.

    6. After your session has been completed, please exit without touching anything other than the doors.

    7. Your card on file will be billed for the treatment.

    8. In between each patient we wipe down and sanitize all surfaces in the clinic with proper chemical agents as well as UV light.

    9. Furthermore, we wipe down the no-touch thermometer, front door, vestibule door and all around the handles (inside and out) in between each patient.

    ALWAYS PRACTICE SOCIAL DISTANCING

  • Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

  • Acceptance & Signature

  • I understand that submitting my full name in the field below constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.