SINGING BODY CLINIC

This section outlines the joint decision (clinician and client) regarding in-person services during the COVID-19 health crisis. Once signed, this is an official agreement that you understand fully the risk in- person services have, and hold harmless the clinician, and all employees of Singing Body Clinic.

Decision to Meet Face-to-Face
You have agreed to meet in-person for some or all future sessions. If there is a resurgence of the pandemic or if other health concerns arise, the clinician may require meetings via telehealth. If you have concerns about meeting through telehealth, you agree to discuss these with your clinician prior to meeting. You also understand that, if the clinician deems it necessary to hold sessions exclusively via telehealth, this is a decision made for everyone’s well-being. If you decide at any time you feel safer starting, staying with, or returning to, telehealth services, the clinician will respect that decision provided it is feasible and clinically appropriate.
You agree to discuss any reimbursement concerns with your clinician prior to meeting via telehealth.

Risks of Opting for In-Person Services
You understand that by coming to the offices of Singing Body Clinic, you are assuming the risk of exposure to COVID-19 (or other public health risk). This risk may increase if you travel by public transportation, cab, or ridesharing service.

Your Responsibility to Minimize Your Exposure
To obtain services in-person, you agree to take certain safety precautions to reduce your risk of exposure, illness, and possible death. If these safeguards are not adhered to, you agree to starting, staying with, or returning to meeting via telehealth. By signing this document, you understand and agree to these actions:
⎯ You will only keep your in-person appointment if you are symptom free.
⎯ You will take your temperature before coming to in-person appointments and if it is elevated (100 Fahrenheit or more), or if you have other COVID-19 symptoms, you will contact the clinician to reschedule or hold the appointment via telehealth. If you are symptomatic and cancel the appointment for this reason, you will not be charged the normal cancellation fee.
⎯ You will wait in your car or outside until no earlier than five [5] minutes before the in-person appointment time.
⎯ You will wash your hands or use alcohol-based hand sanitizer immediately prior to the in-person appointment.
⎯ You will adhere to safe distancing precautions set up in the waiting or session rooms and will not move chairs or sit in areas that may be marked as closed.
⎯ You will wear a mask in all areas of the waiting or session rooms and will not remove your mask until seated in the session room.
⎯ If you bring a child or other family member to the in-person session, you agree that they will also follow these sanitation and distancing protocols.
⎯ You will take steps to minimize your exposure to COVID-19 between in-person appointments.
⎯ If you have been exposed to someone who has tested positive for COVID-19, you will immediately
notify your clinician prior to meeting in-person.
⎯ If you have a job, commute, or other responsibilities/activities that put you in close contact with others who may have COVID-19, you will notify your clinician prior to meeting in-person.

Singing Body Clinic and your clinician reserve the right to change the above precautions to maintain adherence to local, state, or federal orders or guidelines. Any adjustments will be communicated by your clinician prior to meeting.

Our Commitment to Minimize Exposure
Singing Body Clinic clinicians take steps to reduce the risk of spreading COVID-19 in the office and these precautions are posted in the waiting room. Please discuss any questions about our office precautions with your clinician.
If you show up for an in-person appointment and the clinician, or any employee of Singing Body Clinic comes to know that you have been exposed to COVID-19, you will be required to leave the office immediately. Your clinician will follow-up with services via telehealth as appropriate.

If your clinician or any employee of Singing Body Clinic is exposed to COVID-19, you will be notified, so appropriate precautions can be taken.

Your Confidentiality in the Case of Infection
If you have tested COVID-19 positive, Singing Body Clinic may be required to cooperate with local health authorities regarding your presence in the office. If required to report, only the information necessary for contact tracking/public health data collection will be shared. No details pertaining to the reason or content of your appointment will be shared. By signing this form, you agree that Singing Body Clinic can share this information without an additional signed release.

Informed Consent
This agreement supplements the general informed consent signed prior to working with your clinician.

Waiver, Release, and Indemnification
By signing, the undersigned hereby releases, waives, and holds harmless Singing Body Clinic, and its employees, from any and all suits, claims, damages, losses, injuries (including property damage, bodily injury or death), and any other compensable loss of any type (collectively “Claims”) to you and your family directly or indirectly arising out of your participation via in-person sessions. You further agree to defend and indemnify Singing Body Clinic from any and all Claims directly or indirectly arising out of the negligent, reckless or willful acts or omissions of you or your family.