Paths to Wellness
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COVID

COVID 19 
​TOGETHER WE CAN MAKE IT WORK
Paths to Wellness 
Client Informed Consent Form

We believe that an informed client is our best ally in fighting the COVID-19 virus. We will keep you informed of what measures we are taking to ensure your safety and well-being during this unsettled time. We would also ask you to contribute to our efforts by following our guidelines.

We will:
Sanitize all commonly touched surfaces prior to your appointment.
Practice good hand washing techniques prior to any contact with you.
Replace or clean all linens, blankets and bolsters before your appointment.
Change our intake interview to include a brief health questionnaire and temperature check.
Check the temperature of every practitioner on a daily basis.
Thoroughly clean the treatment room following each client.
Wear a cloth face mask at all times.
Provide hand sanitizer and facial tissues in each treatment area.
Clean and sanitize restrooms throughout the day.

We ask you:
To call to change your appointment if you are feeling ill or have been exposed to someone with COVID-19.
To remain in your car until your therapist calls to say she is ready for you to come in.
To wear a cloth face mask the entire time you are in the facility. If you do not have one, we will provide one.
To use hand sanitizer upon arrival
To answer the health questions honestly. We would rather take precautions than deal with the chance of infection!
Contact your provider 2 days after your appointment to tell her how you are feeling or if there has been any changes in your physical health.
To use credit cards over cash or checks for payment.

We hope these protocols will keep everyone safe. We will continue to follow the Virginia’s as well as our professional organizations’ guidelines. Close physical contact still contains a risk. By signing below, you acknowledge that you have read and understood this policy and accept responsibility for any risk incurred.

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Client Signature                                                                                  Date