1. Your therapist will NOT be checking your temperature or screening you for symptoms. By attending your appointment, you are confirming that you are symptomless and have not had a known exposure. Please do not enter if you have any symptoms, or if you have a known COVID exposure.
2. Please ensure you are wearing a mask before entering (your mask must remain on for the duration of your visit).
3. Please enter no earlier than 5 minutes prior to your scheduled appointment.
4. Please utilize hand sanitizer upon entering the waiting room/office suite.
5. Please wait in the designated waiting room (and maintain appropriate social distancing if applicable) for your therapist to greet you. Please note: Our team will NOT be monitoring common areas.
6. Your therapist will be disinfecting/cleaning common areas and therapy rooms in between visits (if games, art, books, or other supplies are utilized, your therapist will be disinfecting them in between visits).
7. While in session, you must wear a mask and adhere to appropriate social distancing.
8. Thank you for helping us keep you, our families, and the rest of our patients safe!
INFORMED CONSENT FOR IN-PERSON SERVICES DURING COVID-19
This document contains important information regarding the decision to receive in-person mental health services during the COVID-19 pandemic. Please read this document carefully, and let your therapist know if you have any questions. By reading, signing, and receiving in-person services, you are agreeing to all of these policies.
DECISION TO MEET FACE-TO-FACE
We have agreed to meet in person for some or all future appointments. If there is a resurgence, and/or if other health concerns arise, your therapist may require you to meet via telehealth. All concerns will be addressed and discussed prior to any applicable changes. At any point in time, you reserve the right to request services be rendered virtually. As long as this is feasible and clinically appropriate, telehealth is an option.
RISKS OF IN-PERSON SERVICES
By coming to the office, you are assuming sole risk of exposure to COVID-19, and/or other public health risks. These risks may also increase by use of public transportation, cab, or rideshare.
YOUR RESPONSIBILITY TO MINIMIZE EXPOSURE
To receive in-person services, you agree to take certain precautions which will help keep everyone (you, me, our families, the TGN team, and other patients) safer from exposure, sickness, and possible adverse reactions to illness including but not limited to death. If you do not adhere to these safeguards, it may result in our starting/returning to telehealth.
I may change the above precautions if additional local, state, or federal orders or guidelines are published. If that happens, we will talk about any applicable changes.
OUR COMMITMENT TO MINIMIZE EXPOSURE
Our practice has taken steps to reduce the risk of spreading the coronavirus within the office, and we have posted these efforts on our site, and around our office space.
IF YOU OR I ARE SICK
Our practice is committed to keeping everyone safe (you, your therapist, the entire TGN team, all of our patients, and our extended families).
If you’ve tested positive and/or have symptoms, please let your therapist know immediately.
If you show up for an appointment and the TGN team believes you have a fever or other symptoms, or believes you have been exposed to COVID-19, we will require you to leave the office immediately. Your appointment will be rescheduled, and you will be charged accordingly. Please note, we will waive late cancelation charges due to COVID-19 related exposures and symptoms, so please contact us PRIOR to your appointment. If you show up and we need to cancel due to concerns for exposure and/or symptoms, you will be charged the full session fee.
If your therapist or anyone on the TGN team tests positive for COVID-19, we will notify you so that you may take the appropriate measures.
YOUR CONFIDENTIALITY IN THE CASE OF INFECTION
If you have tested positive for COVID-19, I may be required to notify local health authorities that you have been in the office. If I have to report this, I will only provide the minimum information necessary for their data collection, and will not go into any details about the reason(s) for our visits. By signing this form, you are agreeing to this without an additional signed release of information.
This agreement supplements the general informed consent/business agreement that we agreed to at the start of our work together. Your signature below shows that you agree to all of the terms and conditions listed in this document.
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