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• I understand that the novel Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). I further understand that COVID-19 is extremely contagious and may be contracted from various sources. I understand COVID-19 has a long incubation period during which carriers of the virus may not show symptoms and still be contagious.

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• I understand that I am the decision maker for my health care. To the best of their ability, my practitioner will provide me with information to assist me in making informed choices. This process is often referred to as “informed consent” and involves my understanding and agreement regarding recommended care, and the benefits and risks associated with the provision of health care during a pandemic. Given the current limitations of COVID-19 virus testing, I understand determining who is infected with COVID-19 is exceptionally difficult.

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• I understand that preventative measures and intensified sanitation protocols intended to reduce the spread of COVID-19 will be implemented. However, because this work involves close physical proximity over an extended period of time in a closed space, there may be an elevated risk of any disease transmission, including COVID-19. I hereby acknowledge and assume the risk of my actions and give my express permission to you and the staff at your offices to proceed with providing care. 

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Thanks for your cooperation and understanding of these guidelines.

I look forward to seeing you at your session.

 

Dave