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COVID-19 Consent Form
Below is our company COVID-19 consent form. This form will be signed by all patients coming into the office going forward. Thank you!

INFORMED CONSENT FOR FACE TO FACE, IN-PERSON SERVICES DURING COVID-19 PUBLIC HEALTH CRISIS

This document contains guidelines for clients wishing to resume in-person services at the Resource Group Counseling & Education Center, Inc.  Please read this carefully and let Resource Group staff know if you have any questions.  Please sign this document to affirm that you have read and understood it, and that you agree to abide by it.

Decision to Meet Face-to-Face

We have agreed to meet in person rather that via telehealth for some or all future sessions. If there is a resurgence of the pandemic or if other health concerns arise, we may resume via telehealth. If you have concerns about meeting through telehealth, we will discuss it together and address any issues as best we can.

Unless your payer stops us from billing for these services you may decide, after giving us warning, to return to telehealth services.

Risks of Opting for In-Person Services

You understand that by coming to the Resource Group offices you are at higher risk of contracting exposure to the coronavirus (or other public health risk). We will do certain things to minimize that risk and, in turn we expect you to do your part.

Your Responsibility to Minimize Your Exposure

To obtain services in person, you agree to take certain precautions which are designed to keep all parties safe from exposure.

You agree to:

  1. Only keep your in-person appointment if you are symptom free.
  1. Have your temperature taken by Resource Group staff before each appointment at Resource Group. If it is elevated (100’F or more), or if you have other symptoms you agree to proceed with the appointment using telehealth. Please ask staff for guidance if you need it.
  2. Wash your hands or use alcohol-based hand sanitizer when you enter Resource Group offices.
  3. Adhere to the safe distancing precautions we have set up in the waiting room and therapy rooms.
  4. Wear a mask in areas of the office outside of your clinician’s office
  5. Keep a distance of 6 feet and avoid physical contact with non-family members.
  6. If you are bringing your child, take responsibility for making sure your child follows these sanitation and distancing protocols.
  7. If a resident of your home tests positive for COVID-19, you agree to call the Resource Group. In that circumstance, unless it is not supported by the payer, you agree to resume services via telehealth.
  8. Resource Group will let your clinician know and anyone with whom you’ve had contact.
  9. By signing below, you indicate that you have read and understood this document, and agree to abide by it.

Resource Group may change the above precautions if additional local, state or federal orders or guidelines are published. If that happens, we will post any changes to our policy to our website (www.resourcegrp.org).

If Resource Group staff to whom you have been exposed, test positive for the coronavirus, we will notify you so that you can take appropriate precautions.

 

If you have tested positive for the coronavirus, and you were in our offices three days or less before you were tested, we ask you or a designated other to call us and let us know.