Uram Family Therapy

Coronavirus Awareness Agreement

Coronavirus Awareness Agreement 20200620

Please review our Coronavirus Awareness Agreement to learn how Uram Family Therapy is taking steps to decrease the risk of infection.

Here is a brief outline of the document:

Coronavirus (COVID-19) Awareness Agreement

Please read this document in its entirety. If you have any questions, please feel free to ask your therapist before signing. You are not required to receive psychotherapy in person.  By coming to the office, you assume the risk of exposure to COVID-19 (or any other health risk). If you are concerned about possible risks to your health, consult with your physician before attending in person meetings and consider telehealth psychotherapy appointments.

For clients that are attending in-office sessions, I will respect your decision should you at any time choose to return to Telehealth services instead of in-person sessions. If at any time it becomes unsafe due to a resurgence of COVID-19 or any other health reasons, I may require that we resume Telehealth sessions. If I determine a return to Telehealth services is necessary for our safety, I will attempt to share that decision with you as soon as practical. By receiving services in person, you will be mindful of the risks to yourself, your therapist, and your family members.

I request the following from you:

  • You will only attend in person sessions if you are free of COVID-19 symptoms. I am happy to provide you with Telehealth services if you are feeling unwell, have a cough, fever, or any sign of illness, even if it is not closely associated with COVID-19.
  • You will adhere to the public health orders addressing requirements for facial coverings (masks) and social distancing to the extent they exist. Presently, the requirement is 6 feet of distance in public and wearing masks as of this updated agreement, which is 6/20/2020.
  • You agree to wash your hands and/or use hand sanitizer prior to entering my office. Hand Sanitizer is available for your use in office. A sink is available in our restroom.
  • If you are working in a job that exposes you to individuals who may be infected, I request that you please let me know prior to our session.
  • I do not recommend attending in person sessions if you are exposed to anyone who may be or has been infected with COVID-19.
  • At Uram Family Therapy, we use disinfectant wipes on all commonly used surfaces regularly throughout the day, and do our best to wipe down the surfaces, door handles, couches and chairs that were used, in between each client.
  • We have Germ Guardian air purifiers with a UV filter that may help in reducing the risk of exposure to COVID-19 in the air. It claims to clean the air in a room the size of 167 square feet every 15 minutes. We have one in each psychotherapy office.
  • We currently prefer to bill through invoicing to support contactless payment.
  • If you or a member of your immediate household tests positive for COVID-19, you should not attend in person sessions. You agree that if this is the case, you will inform me (and my staff) immediately so that we may resume Telehealth sessions.
  • You agree to notify my office ASAP, preferably within 24 hours if you do test positive for coronavirus.
  • There are certain circumstances under which I may be required to notify health authorities that you have been in the office. This typically would only occur if someone who had been seen in my office were to test positive for COVID-19. If this situation arises, and in accordance with applicable privacy laws, I will provide the minimum information necessary for the health authorities to perform their duties.

Name:                                                                                    

Signature:                                                                                                        Date: