INFORMED CONSENT FOR RETURNING TO IN-PERSON PSYCHOLOGICAL SERVICES
This Informed Consent for Returning to In-Person Psychological Services is a supplement to the general informed consent that we agreed to at the outset of our clinical work together. Please read this document carefully, and let me know if you have any questions.
The threat of COVID-19 is ongoing throughout the United States. As a way to mitigate the risk of exposure to COVID-19, our practice has transitioned to providing most services via telecommunications technology. Use of telecommunications technology reduces the need for persons to come into close contact with each other or to be in areas where exposure to COVID-19 may occur. However, in some situations, teletherapy services may not be adequate, and in-person services may be more appropriate.
We have determined that in-person services are appropriate at this time for your situation.
The decision about whether to engage in in-person services is based on current conditions and guidelines, which may change at any time. It is possible that a return to remote services will be necessary at some point based on consideration of health and safety issues. Such a decision will be made in consultation with you, but I will make the final determination based on a careful weighing of the risks and applicable regulations.
It is also important to consider that, although insurance reimbursement for teletherapy services may have been mandated during the COVID-19 pandemic, such mandates may no longer be in effect, and may no longer be reimbursed by your insurance company.
In order for me to provide you with in-person services, the following protocols must be followed by patients/clients and providers:
- Social distancing requirements must be met, meaning that we must maintain a six-foot distance from others wherever possible.
- Patients/clients and providers will agree upon whether they wear face coverings or masks while engaging in Therapy.
- Hand sanitizer will be provided at the office entrance and must be used upon entering the office.
- There will be no physical contact with others.
- You will be asked to wait in your vehicle or outside the office until you receive a text, email, or phone call from office staff indicating that you can enter the office.
- You agree not to present for services if you have a fever, shortness of breath, coughing, or any other symptoms associated with COVID-19, or if you have been exposed to another person who is showing signs of infection or has been confirmed to have COVID-19 within the past two weeks, or if you have tested positive in the last two weeks. PLEASE INITIAL IN THE NEXT BOX TO INDICATE ACKNOWLEDGEMENT OF THIS SECTION.
- If you are bringing a child or other dependent in for services, you agree to ensure that both you and your child/dependent follow all of these protocols.
- Only current clients are allowed in the office at this time with the exception of legal guardians.