Return to Office during covid-19

Therapist Full Name *

MUST BE AN INDIVIDUAL RESPONSIBLE FOR OFFICE AGREEMENT.

First Name

Last Name

Phone *

(###)

###

####

Date *

Please indicate date you plan to begin in-person sessions

MM

DD

YYYY

Policy + Procedures *

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

Upon Entering the Office: Put on a face mask + Sanitize your hands. Sanitizer will be provided by New Beginning Family Counseling & Training Center upon entry in the office waiting room for your use + clients. However, each clinician is responsible to have their own in the event that it is not available.

Opening + Closing: The first person to enter will sanitize the door handles and high touch areas. The last person to leave will sanitize the door handles and high touch areas.

Throughout the Day: All must clean their hand after each in-person interaction and after washroom use. Therapist to wear a face mask when in session with in-person therapy clients.

When Client Comes into the Office: All therapists must screen their in-person clients before they attend each session via phone, email or text. This should be done the day of their appointment, at least one hour before their appointment.

If a client answers yes to any of the screening questions they must continue telehealth and not come into the office.

COVID-19 Screening Questions: Have you traveled in the past two weeks? Have you experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing)? Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?

Clinician will document that client responded NO to the COVID-19 screening questions each office visit.

There will be a station near the front door of each location, upon entering. This station will be equipped with hand sanitizer + cleaning wipes.

When a client enters the office, please ensure that the client: 1. Is asked the screening questions again. If they answer yes to any of the questions, please cancel the in office appointment and reschedule for telehealth. 2. Sanitizes their hands thoroughly. 3. Puts on a mask.

Waiting Room + Common Areas: Waiting room is only open to clients for minimal to time while clinician gets client for their appointment. If someone is with them, please ask that they wait outside or in their car, for the safety of everyone in the office. Please wash your hands before use of any items in the common areas (ie. coffee station, printer, microwave, refrigerator).

Therapy Rooms: Therapist will open and close therapy room door for clients. Therapist will sanitize high touch areas of their office after each in-person client session.

Therapist to ensure all in-person clients wear a face mask.

Notification of Supply Shortage: If you notice that the office hand sanitizer or surface cleaning wipes are running low, please notify Yanira directly via email at contact@nbcounselingtc.com. Please don’t wait until you use the last of something to notify Yanira. With current shortages, it may take some time to find and ship materials. Once the last bottle is beginning to be used or the last box of wipes is opened, please notify Yanira to restock.

Despite New Beginning Family Counseling & Training Centers’ best effort to mitigate the virus in the office, we do not have the ability to supervise every person’s actions throughout the day and cannot guarantee with certainty a person will not contract the virus. *

I have read this and acknowledge New Beginning Family Counseling & Training Centers’ best practices for returning to office policy and procedure.

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