INFORMED CONSENT FOR IN-PERSON SERVICES DURING
THE COVID-19 PUBLIC HEALTH CRISIS
Gordon Therapy Group/Tamar Gordon Psychology, PLLC is committed to creating a safe environment where individuals can work towards both mental health and physical health. With that in mind, this document contains important information about the option to resume in-person services. Please read this carefully and let me know if you have any questions. When you sign this document, it will be an official agreement between us.
Decision to Meet Face-to-Face
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 decide at any time that you would feel safer staying with or returning to telehealth services, I will respect that decision, as long as it is clinically appropriate. Reimbursement for telehealth services, however, is determined by the insurance companies and applicable law, so it may or may not continue to be covered.
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).
Your Responsibility to Minimize Your Exposure
To obtain services in person, you agree to take certain precautions to help keep everyone (you, me, our families, and other patients) safer from exposure. If you do not adhere to these safeguards, we will return to a telehealth arrangement.
- Health requirement #1, anyone 12 and older:
- You agree to attend in-person session only if you are fully vaccinated against the COVID-19 virus. The means that you are at least two weeks past the date of your second vaccination shot.
- Health requirement #2, all ages:
- You agree to attend in-person session only if you are not experiencing any cold, viral or other symptoms of illness. If you are ill, you must do the session by telehealth or reschedule. Anyone attending a session who appears ill, will be immediately sent home
- Waiting room Restriction:
- The waiting room is only available to patients in a limited capacity in order to decrease the number of people in our office. Please only arrival in-time for your session and leave immediately after your session. Only patients (and parents/babysitters of minors) will be allowed in the waiting room.
- Masks
- We require everyone to wear a mask covering their mouth and nose while in the office
Your Confidentiality in the Case of Infection
If you or anyone in your family test positive for the coronavirus, please inform us immediately. Likewise, we will inform you if anyone you have had contact with in the office tests positive for coronavirus. If you have been in the office and the current laws required me to notify local health authorities, I will only provide the minimum required information and will not go into any details about the reason(s) for our visits. By signing this form, you are agreeing that I may do so without an additional signed release.
Informed Consent
This agreement supplements the general informed consent/business agreement that we agreed to at the start of our work together.