Office USE during covid-19

Therapist Full Name *

MUST BE AN INDIVIDUAL RESPONSIBLE FOR OFFICE AGREEMENT.

First Name

Last Name

Phone *

(###)

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Date *

Please indicate date you plan to begin in-person sessions

MM

DD

YYYY

Acknowledgment *

BY CLICKING ON EACH CHECKBOX BELOW I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE OFFICE USE ACKNOWLEDGMENT DURING COVID-19.

All clients and therapists must wear a face mask when in the common spaces.

All clients and therapists must wear a face mask at all times, including in the therapist office.

All clients and therapists must wash or sanitize their hands upon entering the building and after they use the restroom.

All clients and therapists must maintain 6 feet of distance from anyone in the building, unless they are from the same household.

All clients and therapists must wait to enter the office until the start time of their session.

Only clients are allowed in the office. For children under 18, one parent/guardian may accompany the client. Children and family members who are not clients must wait in the car or outside the office.

All clients understand they will be asked COVID-19 screening questions about any symptoms they have.

Clients and therapists who test positive for COVID-19 and have attended an in-person therapy session/been at the office in the past 2 weeks must notify Yanira immediately at contact@nbcounselingtc.com.

If you should test positive for COVID-19, any office use must be paused, for the duration of two weeks or until you are cleared by a doctor.

Due to the long incubation period of the COVID-19 virus, as well as the reality that an individual may be a carrier of the virus without any symptoms or awareness, face to face contact with any other member of the community increases risk of transmission of the virus.

New Beginning Family Counseling & Training Center will continue to provide individual, couples and family therapy via a telehealth platform. We strongly suggest that clients continue to use telehealth for therapy services and that in person sessions be used for clients with whom telehealth is not possible or suggested, such as clients with privacy or safety issues, clients who receive therapy by certain modalities that are not conducive to telehealth, and clients who need a higher level of care.

By choosing in person sessions over telehealth, you recognize the increased risk of contracting the virus in the office and accept that risk.

Client/Therapist Acknowledgement *

I confirm that I have read + informed my clients of the Notice above and understand and accept that there is an increased risk of contracting the COVID-19 virus in coming to this office and being in this office for in person sessions. My clients and I understand and accept the additional risk of contracting COVID-19 from contact at this office. My clients and I also acknowledge that I could contract the COVID-19 virus from a multitude of sources outside this office and unrelated to my visit here. My clients and I acknowledge it would be very difficult for anyone to prove from whom or where they contracted COVID-19. My clients and I assume the risk of being in this office and proceeding with services at New Beginning Family Counseling & Training Center.

First+Last Name *

By typing/entering my full name below, I am doing so in lieu of a signature and it will be equivalent to my legal signature to give validity to this written communication.

First Name

Last Name