At the Cognitive Clinic 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, if it is feasible and clinically appropriate. Reimbursement for telehealth services, however, is also determined by the insurance companies and applicable law, so that is an issue we may also need to discuss.
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, other staff and other clients) 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. Initial each to indicate that you understand and agree to these actions:
You will only keep your in-person appointment if you are symptom free. ___
You will allow us to take your temperature when you enter our office. If it is elevated (100 Fahrenheit or more), or if you have other symptoms of the coronavirus, you agree to cancel the appointment or proceed using telehealth. If you wish to cancel for this reason, I won’t charge you our normal cancellation fee. __
You will wait in your car or outside [or in a designated safer waiting area] until contacted to come up upstairs to our office. ___
You will wash your hands or use alcohol-based hand sanitizer when you enter the office. ___
You will adhere to the safe distancing precautions we have set up in the waiting room and therapy room. For example, you won’t move chairs or sit where we have signs asking you not to sit. __
You will wear a mask in all common areas of the office (I and others will too). ___
You will keep a distance of 6 feet in the therapy room and there will be no physical contact (e.g. no shaking hands) with me [or staff]. ___
You will try not to touch your face or eyes with your hands. If you do, you will immediately wash or sanitize your hands. ___
The decision to wear a mask in the therapy room will be mutually made by you and me. ___
If you are bringing your child, you will make sure that your child follows all of these sanitation and distancing protocols. ___
If a resident of your home tests positive for the infection, you will immediately let me [and my staff] know and we will then [begin] resume treatment via telehealth. ___
Payment for services will be made over the phone. ___
No food or drinks will be offered. You may bring your own beverage. ___
If you use the restroom, please sanitize the key when returning it to our office. ___
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
My practice has taken steps to reduce the risk of spreading the coronavirus within the office and we have posted our efforts in the office. 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, [my staff] and all of our families safe from the spread of this virus. If you show up for an appointment and I [or my office staff] 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 [or my staff] 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.