IN-PERSON SERVICES
POST PUBLIC HEALTH EMERGENCY
The COVID-19 PHE was formally ended on May 11th 2023. Although the PHE declaration has ended there may still be some risks to in-person meetings.
Decision to Meet In Person
We have agreed to meet in person for some or all future sessions. Please understand that if there are any future state emergency limits, shelter in place orders or illness impacting our ability to meet, we will develop a reasonable plan to reschedule or meet using tele-mental health or alternative communication resources that meet the confidentiality requirements necessary to work together.
If you decide at any time that you are comfortable moving or returning to tele-mental health services, we will outline the plan and confirm that the communication method is clinically appropriate. The plan will include payment/reimbursement for tele-mental health services as it may vary with your health insurance plan and applicable law.
Risks of Opting for
In-Person Services
Please understand that by coming to the office, and/or meeting for such services in any other venue, you are assuming the risk of exposure to the coronavirus (or any other public health risk); and you agree to waive all rights and claims against my practice and me both jointly and severally for damages arising therefrom. This risk may increase if you travel by public transportation, cab, or ridesharing service.
Practice Steps to Reduce
Exposure
My practice has taken steps to reduce the risk of spreading the coronavirus within the office and during home-based care. I will continue to follow the guidelines outlined by the CDC, State of CA, and County of Santa Cruz to improve safety and minimize potential exposure. Although no longer required the use of a mask is one way to reduce risk. I will gladly wear a mask if that is your preference. You may also choose to wear a mask during our in-person visits.
Commitment to Minimize Your Exposure
To obtain services in person,
you agree to take reasonable safety precautions to (you, your family members,
my staff, other clients and I) reduce exposure from any contagious illness. If
you do not adhere to these safeguards, it may result in immediate changes in
our meeting arrangement.
Please initial each to indicate that you understand and agree to these actions:
• I agree to only come to an appointment when I am symptom free.
Symptoms include recent onset of one or more of the following: body aches, loss of smell or taste, headache, diarrhea, vomiting, coughing, shortness of breath, difficulty breathing, fever, chills, sore throat or any newly discovered health symptom associated with any contagious virus.
• If I have been exposed to, shared a workspace or living arrangement with a person who has tested positive for COVID-19, I will immediately disclose the information in advance of our appointment time by phone and we will work together to set up a new meeting time or possible alternative means of communication.
• I understand that if I appear to be physically ill at an appointment, I may be required to leave immediately and understand I will be contacted to reschedule our appointment, possibly temporarily involving another form of communication.
The above precautions will be adjusted, if additional local, state or federal orders or guidelines are published. If that happens, the content may be subject to change, and we will review the changes.
Informed Consent
This agreement supplements the general informed consent/business agreement that we agreed to at the start of our work together.