INFORMED CONSENT FOR IN-PERSON SERVICES DURING COVID-19 PUBLIC HEALTH CRISIS
Your Responsibility to Minimize Your Exposure
To obtain services in person, you agree to take certain precautions which will help keep everyone safer from exposure, sickness and possible death. If you do not adhere to these safeguards, you will be asked to reschedule your appointment.
• You will call to schedule your appointment before coming to the office
• Complete this REQUIRED consent form prior to each appointment
• Call our office from the parking lot prior to entering to help minimize contact with other patients
• All patients must wear a mask or face covering to enter the office
• Please come unaccompanied to your appointment – no friends or family members
• All patients will wash their hands upon arrival and will be given gloves to wear during the duration of their appointment
• All patients will have their temperature taken at each appointment. If your temperature is above 99.6° F, you will be asked to reschedule
• If you or anyone you may have had recent contact with is experiencing the following symptoms, please contact our office to reschedule your appointment:
• Fever, chills, muscle pain, body aches, headache, sore throat, new loss of taste or smell, shortness of breath, difficulty breathing
