Consent for Returning to In-Person Psychological Services
This 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 for the following reason(s): Please write the reasons that you believe in-person services best you’re your needs:
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 teletherapy 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 you must maintain a six-foot distance from others while in offices, waiting rooms, and other areas.
· a text, email, or phone call from office staff indicating that you can enter the office.
· Wear a mask to the office
· Wait in your car before your appointment. Text message me at 717-966-1210 when you arrive. I will open the door, so that your visit can be as contact-free as possible.
· Cancel your appointment (no cancellation fee), or ask for tele-counseling session if you have any symptoms associated with the virus such as cough, shortness of breath, or if you have a of temperature of 100.4 degrees Fahrenheit, or higher.
· Maintain a distance of at least six feet from other individuals.
· Wash hands with soap and water for at least 20 seconds or use hand sanitizer if soap and water are not available prior to your visit. I will have some available in the office if needed as well.
· Please make all reasonable attempt to use your restroom before you come, only using the office one when essential. We share the restroom with all members of The Candy Factory, and we are attempting to consider the welfare of all. Again, we are flattening the curve wherever possible.
· Cover coughs or sneezes with a sleeve or elbow, not hands.
· Do not shake hands.
· All seats and tables will be sanitized between client sessions to provide as safe an environment as possible for you and for the next client following you.
· As COVID-19 regulations continue to evolve, I may become legally required at some point to disclose that you and I have been in contact, especially if either of us were to test positive or show signs of COVID-19 infection. If I am legally compelled to disclose information, I will inform you and will only provide the minimum necessary information (e.g., your name and the dates of our contact) required by law.
We remain committed to following state and federal guidelines and to adhering to prevailing professional healthcare standards to limit the transmission of COVID-19 in our offices. Despite our careful attention to sanitization, social distancing, and other protocols, there is still a chance that you will be exposed to COVID-19 in our office. If, at any point, you prefer to stop in-person services or to consider transitioning to remote services, please let me know.
By signing below, you acknowledge that you understand that there is still a potential risk of exposure and that you agree to follow the safety protocols outlined above in order to engage in in-person services.