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This document contains important information about our decision (yours and mine) to begin/resume in-person services in light of the COVID-19 public health crisis. Our decision is based in part on recommendations by the Center for Disease Control (CDC), but other factors may be considered. Some of these include but are not limited to: whether we and our families have been vaccinated, our health or the health of those we are in close contact with, and risk of exposure outside of this setting. There may be other concerns that we can talk about.

Decision to Meet Face-to-Face

We have agreed to meet in person for some or all future sessions. If there is a resurgence of the pandemic or if other health concerns arise, however, I may require that we meet via telehealth. If you have concerns about meeting through telehealth, we will talk about it first and try to address any issues. You understand that, if I believe it is necessary, I may determine that we return to telehealth for everyone’s well-being.

If you decide at any time that you would feel safer staying with, or returning to, telehealth services, I will respect that decision, as long as it is feasible and clinically appropriate. Reimbursement for telehealth services is also determined by the insurance companies and applicable law, so we’ll discuss any financial implications if needed.

Risks of Opting for In-Person Services

You understand that by coming to the office, you are assuming the risk of exposure to the coronavirus (or other public health risk). This risk may increase if you travel by public transportation, cab, or ridesharing service.

Your Responsibility to Minimize Your Exposure

To obtain services in person, you agree to take certain precautions which will help keep everyone (you, me, and our families, and other patients) safer from exposure, sickness and possible death. If you do not adhere to these safeguards, it may result in our starting / returning to a telehealth arrangement.

•You will provide proof of full vaccination.

•You will only keep your in-person appointment if you are symptom free.

•You will only keep your in-person appointment if you have been fever free for a minimum of 10 days prior to our appointment.

•You will cancel your appointment if you have been in contact with someone who has tested positive within the last 14 days.

•If you have any symptoms of the coronavirus, you agree to cancel the appointment or proceed using telehealth. If you wish to cancel for this reason,
you will not be charged the normal cancellation fee.

•You will wash your hands or use alcohol-based hand sanitizer when you enter the building.

•You will wear a mask in all areas of the office (I will too).

•You will keep a distance of 6 feet and there will be no physical contact with me.

•You will take steps between appointments to minimize your exposure to COVID.

•If a resident of your home tests positive for the infection, you will immediately let me know and we will then [begin] resume treatment via 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 necessary changes.

My Commitment to Minimize Exposure

•Office seating in the waiting room and office has been arranged for appropriate physical distancing.

•Masks are required in the building.

•We will maintains safe distancing.

•Restroom soap dispensers are maintained and everyone is encouraged to wash their hands.

•Hand sanitizer that contains at least 60% alcohol is available in the therapy/testing rooms, the waiting room and at the reception counter.

•We schedule appointments at specific intervals to minimize the number of people in the waiting room.

•Commonly touched areas are thoroughly sanitized after each use.

•Physical contact is not permitted.

•Tissues and trash bins are easily accessed. Trash is disposed of on a frequent basis.

•Common areas are thoroughly disinfected at the end of each day.

Please let me know if you have questions about these efforts.

If You or I Are Sick

You understand that I am committed to keeping you, me, and all of our families safe from the spread of this virus. If you show up for an appointment and I believe that you have a fever or other symptoms, or believe you have been exposed, I will have to require you to leave the office immediately. We can follow up with services by telehealth as appropriate.

If I test positive for the coronavirus, I will notify you so that you can take appropriate precautions.

Your Confidentiality in the Case of Infection

If you have tested positive for the coronavirus, 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.

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