COVID-19 office procedures
We take your health very seriously. Please be assured we are doing everything possible to minimize your risk and possible exposure to the coronavirus. Here's what we ask of you and what you can expect when you come in to the office:
Please cancel or reschedule your appointment if you have cold/flu like symptoms. Please cancel or reschedule if you've had known contact with someone diagnosed with or suspected to have COVID-19.
Please wear a mask covering your nose and mouth for the duration of your office visit. If you do not have a mask with you, one will be provided.
Please wash your hands with soap and water for twenty seconds upon entering the office or use your personal or office-provided hand sanitizer. Hand washing preferred.
All highly touched surfaces will be disinfected in between each patient encounter with disinfecting wipes or spray.
An air purifier will be operating for the entirety of business hours. Fans will be on to promote air turbulence and increase air circulation.
Contactless temperature may be taken at the beginning of your appointment. You will be asked to leave immediately and reschedule if your temperature is 100.4 degrees Fahrenheit.
Please arrive to the office on time for your appointment. If you arrive early, please wait outside as the waiting area is not available to you beforehand. The front office door will be locked between treatments so don't panic, we'll be with shortly!
All patients will be asked to sign the following COVID-19 consent to treat waiver:
I consent to receive treatment/examination from New Element Chiropractic during the COVID- 19 outbreak. I understand there is much to learn about the newly emerged COVID-19 including how it spreads and how it is transmitted. 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. I understand that close contact can occur from being within approximately 6 feet of someone with COVID-19 for a prolonged period of time or by having direct contact with infectious secretions from someone with COVID-19. I understand that carriers of COVID-19 may not show symptoms but may still be highly contagious. I understand that due to the unknowns of this virus and the number of other patients that have been in the practice, that I have an increased risk of contracting the virus by being in the practice and by receiving treatment in the practice.
I understand that the symptoms listed below are representative of COVID-19:
● fever ● dry cough ● shortness of breath ● loss of taste or smell ● persistent pain or pressure in the chest ● bluish lips or face ● extreme fatigue ● headache ● sore throat ______ (initial)
I confirm that I do not display or currently have any of the symptoms that are representative of COVID19, which are outlined above: _______ (initial)
I understand that all travelers arriving from a country or region with widespread ongoing transmission, as outlined by the CDC, should stay home for 14 days to practice social distancing and monitor their health after their arrival: _______ (initial)
I confirm that I have not traveled to any of the countries or regions with widespread ongoing transmission (Level 3 Travel Health Notice) in the past 14 days. _____(initial)
I confirm, to the best of my knowledge, that I have not had close contact with an individual diagnosed with COVID-19 in the past 14 days. _______ (initial)
I confirm that if any of the above initialed sections change for me personally, I will notify New Element Chiropractic and will reschedule my appointments. ________ (initials)
Patient’s Name:________________________________________________________ Patient Signature:______________________________________________________ Date:_____________________
Doctor Signature:______________________________________________________ Date:_____________________