I consent to receive treatment from Serenity Behavioral Health
Services, in the office for my mental health counseling. I know that tele-therapy is an option that is still available to me.
I understand that based on what is currently known about COVID-19 the spread is thought to occur mostly from person-to-person via respiratory droplets among close contacts. Receiving in-person counseling means that I will within 3-6 feet with my therapist within a closed room. I understand that Serenity-BHS is following CDC guidelines with cleaning the spaces to decrease risk of spread of the virus. I also understand that all of the therapists and staff are committed to monitoring their own health to ensure that they do not provide in-person office counseling if they have any symptoms or been exposed by anyone who has
been exposed to COVID-19.
I understand that carriers of COVID-19 may not show symptoms but may still be highly contagious. I understand that the symptoms listed below are representative of COVID-19:
● Dry Cough
● Shortness of Breath
● Persistent pain or pressure in the chest
● Bluish lips or face
I confirm that I do not display or currently have any of the above symptoms nor have I had close contact with an individual experiencing symptoms of or been diagnosed with COVID- 19 in the past 14 days.