Ann Arbor Behavioral Health Associates is a private group practice located in Ann Arbor, MI. We provide individual and family therapy services in addition to parent consultation and LLMSW supervision. Ann Arbor Behavioral Health is committed to providing high quality, safe, confidential, and ethical services for all of our clients. We understand that people come to us from a variety of backgrounds and experiences, and we strive to honor that in treatment. Please contact us to learn more about the services we offer.
COVID-19 Precautions and Informed Consent
This document contains important information about your therapist's and your decision to begin/resume in-person services in light of the COVID-19 public health crisis. The decision is based in part on recommendations by the Center for Disease Control (CDC), but other factors may be considered. Some of these include but are not limited to: whether individuals and families have been vaccinated, personal health or the health of those we are in close contact with, and risk of exposure outside of this setting. There may be other concerns that can be discussed with your therapist.
1. Decision to Meet Face-to-Face. I agree that my therapist and I will meet in person for some or all future sessions, as agreed upon by myself and my therapist. My therapist may request at any time that we end in-person sessions and return to telehealth sessions if she feels it is necessary to maintain the safety and health of myself and others. This includes, but is not limited to, a resurgence of the pandemic or other health concerns. If I decide at any time that I would feel safer staying with, or returning to, telehealth services, my therapist will respect that decision, as long as it is feasible and clinically appropriate. Reimbursement for telehealth services, however, is also determined by the insurance companies and applicable law. I am ultimately responsible to verify my telehealth benefits for behavioral health. I may discuss any related concerns with my therapist.
2. Risks of Opting for In-Person Services. I understand that by coming into the office, I am assuming the risk of exposure to COVID-19 (or other public health risk). This risk may increase if I travel by public transportation, cab, or ridesharing service.
3. Your Responsibility to Minimize Your Exposure. I agree to take certain precautions which will help keep everyone (myself, my therapist, families, staff, other clients) safer from exposure, sickness and possible death. If I do not adhere to these safeguards, it will result in starting/returning to a telehealth arrangement. My check below indicates that I have read and understand the following: I understand that I will not be charged for cancelled appointments due to illness. I understand that if I am ill and do not contact my therapist prior to the start of our scheduled appointment, I am responsible for the missed appointment fee. I will only keep my in-person appointment if I am symptom free (this pertains to all symptoms of illness, not just those associated with COVID-19) of fever, cough or shortness of breath. I will only keep my in-person appointment if I have NOT traveled by airplane in the past 14 days, been in contact with someone diagnosed with COVID-19 or been in contact with someone presenting with symptoms. I will take my and/ or my child's temperature before each appointment. If it is elevated (100 degrees Fahrenheit or more), or if I have other symptoms of COVID-19, I agree to cancel the appointment or proceed using telehealth. I understand that the waiting room will be closed. I will arrive at my appointment time or no earlier than 5 minutes prior to reduce potential exposure. I will wash my hands or use alcohol-based hand sanitizer when I enter the building. I will adhere to social distancing (6’) when possible. There will be no physical contact. I understand that hand sanitizer will be available to me throughout my appointment if needed. I will not bring anyone with me to my appointment that is not needed for the appointment. I will take steps between appointments to minimize exposure to COVID-19. If my job exposes me to other people who are infected, I will immediately let my therapist know. If my commute or other responsibilities or activities puts me in close contact with others (beyond my family), I will let my therapist know. If a resident of my home tests positive for the infection, I will immediately let my therapist or administrative staff know, and I will resume treatment via telehealth.
3b. FOR PEDIATRIC CLIENTS: If I am bringing a child to an appointment, I agree to assist my child in following these precautions. If I am bringing a child to an appointment, I understand that their therapist may request that we bring our own materials (i.e. games, markers, toys) to their session to minimize exposure risks. Please note: the above precautions may be changed if additional local, state or federal orders or guidelines are published.
4. I understand that my therapist will wear a face covering for the duration of my session. I agree that myself and/or my child will wear a face covering while in the building. I understand that if I refuse to wear a face covering, I will be asked to leave the office and reschedule for a telehealth appointment.
5. Therapist’s Commitment to Minimize Exposure. Ann Arbor Behavioral Health Associates has taken steps to reduce the risk of spreading COVID-19 within the office and has posted these efforts on the company website and in the office. Ann Arbor Behavioral Health Associates may change the above precautions if additional local, state or federal orders or guidelines are published. If that happens, we will talk about any necessary changes. Please let your therapist know if you have questions about these efforts.
6. If You or I Are Sick. I understand that my therapist is committed to keeping me, herself, staff, and everyone’s families safe from the spread of this virus. If I show up for an appointment and my therapist believes that I have a fever or other symptoms, or believes I have been exposed, my therapist will require me to leave the office immediately. I can then follow up with services by telehealth as appropriate. If my therapist or staff at Ann Arbor Behavioral Health Associates tests positive for the coronavirus, I will be notified so that I can take appropriate precautions.
7. Your Confidentiality in the Case of Infection. If you have tested positive for COVID-19, Ann Arbor Behavioral Health Associates may be required to notify local health authorities. If reporting occurs, the minimum amount of information necessary for data collection will be disclosed. By signing this form, you are agreeing that Ann Arbor Behavioral Health Associates may disclose demographic information to the local health authorities without an additional signed release.