Clawson Physical Therapy
CLAWSON PHYSICAL THERAPY 1075 Fulton Avenue, Suite A6915 Elk Grove Blvd., Suite A Sacramento, CA 95825 Elk Grove, CA 95758 916.488-4000 916.684-3000 916.488-4005 916.684-3003 SUPPLEMENTAL INFORMED CONSENT Physical Therapy Treatment in the Era of COVID-19Thank you for your continued trust in our practice. As with the transmission of any communicable disease like a cold or the flu, you may be exposed to COVID-19, also known as “Coronavirus,” at any time or in any place. Be assured that we have always followed state and federal regulations and recommended universal personal protection and disinfection protocols to limit transmission of all diseases in our office and continue to do so.Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our office, just as you might be at your gym, grocery store, or favorite restaurant. “Social Distancing” nationwide has reduced the transmission of the Coronavirus. Although we have taken measures to provide social distancing in our practice, due to the nature of the procedures we provide, it is not possible to maintain social distancing between the patient, therapist, therapy staff and sometimes other patients at all times.Although exposure is unlikely, do you accept the risk and consent to treatment for the length of the current plan of care?YES________ NO___________________________________________________ ________________Patient/Responsible Party Signature Date___________________________________________Printed Name ................
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