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Covid 19 Informed Consent For In Person Occupational Therapy Services

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Covid-19 Informed Consent for In-Person Occupational Therapy Services

Therapy Consent

Page 1

Please read the following information carefully and sign below to indicate your understanding and agreement.

Email*

Full Name*

Date of Birth*

Address*

Phone Number*

Emergency Contact Name*

Emergency Contact Phone Number*

Date of Service*

Select date

Have you been diagnosed with COVID-19?*

10.

Have you been in close conta...*

11.

Have you traveled outside of...*

12.

Have you experienced any of ...*

13.

Please describe any addition...

Description:Get informed consent for in-person occupational therapy services during Covid-19 with this easy-to-use Therapy Consent form template. Ensure the safety of your clients and staff by collecting necessary information and signatures.

Protect your clients and staff during the Covid-19 pandemic with this Therapy Consent form template. This form will help you get informed consent from your clients before providing in-person occupational therapy services. The form includes important questions related to Covid-19 symptoms, exposure, and travel history. It also includes a liability waiver and signature fields for both the client and therapist. By using this form, you can ensure that you are taking all necessary precautions to prevent the spread of Covid-19 and keep everyone safe.

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Please provide a brief description of the audio.*

When was the audio recorded?*

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