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, or amend our COVID policies. 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.
- You will only keep your in-person appointment if you are symptom free (from any contagion).
- You will only keep your in-person appointment if you have not had a known or possible exposure to COVID-19 and/or other contagious diseases. Late cancellation fees will be waived for cancellations due to these reasons only, but please notify us as soon as you know, even if you are hoping to be better by your scheduled appointment.
- If either 1 or 2 applies, you will cancel your appointment or request a telehealth session.
- The TGN team will not be taking your temperature or screening you for symptoms at the time of your appointment. By coming to your appointment, you are acknowledging that you are symptom free of any contagious disease.
- You will enter the suite/waiting room no earlier than 5-minutes prior to your scheduled appointment time.
- You will wash your hands and/or use alcohol-based hand sanitizer upon entering the suite.
- At this time, masks are NOT required, and will remain optional for both patients and clinicians. We try to keep masks in the office for patients, but cannot guarantee ongoing availability.
- You will adhere to the safe distancing precautions in both the waiting room and therapy room.
- You will try not to touch your eyes or face with your hands.
- You will take steps in between appointments to minimize your exposure to COVID-19 and other contagions.
- If you have a job that puts you at increased risk for contracting or working with those infected by COVID-19, you will let me know.
We 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 CLINICIAN 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 or another contagious disease, 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 cancellation 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.