• Informed Consent for In-Person Services during COVID-19 Public Health Crisis

  • Decision to Meet In Person

    I consent to meeting in person with my therapist Anne G. Walker LCSW. If there is a resurgence of the pandemic or if other concerns arise my therapist may require that we meet via telemental health. Should I be unable to participate in telemental health I will notify my therapist of barriers and we will create a plan for care.

    I may voluntarily request telemental health services at any time. My therapist will advise on clinical appropriateness related to my care. Additionally I am aware there may be reimbursement limitations as determined by my health insurance carrier. 

    Risks of Opting for In-Person Services

    I understand that by presenting to my therapist's office I am assuming the risk of exposure to the coronavirus or any other public health risk. 

    My Responsibilty to Minimize Exposure

    To obtain services in person, I agree to taking certain precautions which helps reduce risk to myself, my therapist, related office staff, and other clients receiving care. Should I be unable to adhere to these standards I agree to notify my therapist and discuss care plans which may include virtual sessions. 

  • Office Commitment to Minimizing Exposure

    I understand that my therapist has made every effort to provide a healthy and safe environment for her clients, including use of alcohol based hand sanitizer, social distancing, mandated mask wearing, and requiring all age or health eligible clients to be vaccinated for COVID-19 for in-person sessions. My therapist may be required to notify public health authorities should a positive case has presented in her office. Only minimal information that is necessary for case tracking and data collecting will be provided. 

    This agreement supplements the general informed consent that was signed at the initiation of care. My signature confirms my agreement to these terms and conditions. 

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