Counseling & Psychotherapy

 Covid -19 Risks and Precautions

The existence of the Covid-19 virus adds risk to scheduling an in-person appointment for therapy and requires additional precautions. This outlines the risks and the precautions taken.

By coming to the office, you are assuming the risk of added exposure to the coronavirus (or other public health risk). This risk may increase if you travel by public transportation, cab, or ride-sharing services .

If You or I Are Sick: During an in-person session, if either of us show symptoms of coronavirus, or if I believe either has been exposed, we will terminate the meeting and follow up as appropriate.

If I, or anyone else in the building tests positive for the coronavirus, I will notify you.

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. By signing this form, you are agreeing that I may do so without an additional signed release.

Your Responsibility to Minimize Your Exposure/Conditions for meeting in person: To obtain services in-person, you will need to agree to certain precautions which will help reduce potential exposure to coronavirus, to include:

____ Scheduling an in-person session and signing the COVID disclosure document creates an agreement between us regarding                    meeting in person.   
____ Full vaccination against Covid-19, with a minimum 2 weeks since final dose is required for in person sessions. Proof of                            vaccination may be requested.
____ Face masks are worn at all times while in the public areas of the office.   If I arrive without a  mask, I will wait outside                              and text my Provider to let them know I have arrived.  A face mask will be provided so that you may access the public areas of            the building.
____ I will agree to keep my in-person appointment only if I am symptom-free. If my temperature is elevated or I have other                          symptoms of  the coronavirus, or have tested positive I agree to meet using telehealth or cancel the appointment.
____ I will agree to use alcohol-based hand sanitizer (available in the office) as I enter and if I touch my face or eyes while we are                  meeting.
____ I will agree to maintain a distance of 6-feet from others I may encounter near or outside the building.
____ I will agree to remove my face mask once inside my providers office
____ I understand there will be no physical contact (e.g. no shaking hands)
____ I understand the patient bathroom located on the first-level will remain open for my convenience, and that I assume any risk of          infection associated with using this bathroom
____ I agree to take steps between appointments to minimize my exposure to COVID-19.

I agree to let my provider know immediately if:
            _____ If my job, commute or lifestyle exposes me to other people who are infected
            _____ If a resident of my home tests positive for the infection
_____ I understand these conditions are a requirement to meeting in person.

As conditions change and CDC guidelines, local, state or federal orders or guidelines are published, these precautions may be revised. If that happens, we will talk about any necessary changes.

Commitment to Minimize Exposure:These conditions and precautions are in place to allow us to meet in-person while reducing the risk of spreading the coronavirus within the office. Other precautions include:
     - Hepafilters/air purifier will be used in public areas and in my office
     - All tenants/providers in the office building are fully vaccinated
     - Patients entering the building are to be fully vaccinated, except for children
     - Masks will be worn in public spaces at all times - The office will be cleaned weekly