COVID-19 Consent Form
At Ghada Y. Afifi, MD, your health and the health of our staff are of the utmost importance. To ensure your health and the health of our staff, we do follow usual universal precautions in our operatories and office.
If you have an illness or are exhibiting symptoms of covid or any illness, we recommend you cancel and reschedule your appointment. Some illness and symptoms include:
- a cold or the flu
- fever or nausea
- severe headaches or body aches
- muscle or stomach pain, chest pain or difficulty breathing
- vomiting or diarrhea
- active tuberculosis (TB)
- mumps, measles, chickenpox
- other contagious disease
Please notify our staff before your appointment if you or someone you are in close contact with have recently traveled to one of the countries with large outbreaks of COVID-19 (ex. China, Italy, Iran, South Korea) or if you have been exposed to someone else who was diagnosed with COVID-19 or who was quarantined as a precaution.
If you are healthy, there’s no need to cancel your regularly scheduled appointment.
UPDATED NEW OFFICE PROTOCOL: IN EFFECT NOW
MANDATORY COMPLIANCE FOR PATIENT AND STAFF SAFETY:
ALL MUST WEAR MASK: YOU WILL NOT BE ALLOWED IN OFFICE WITHOUT MASK as we do see some immunocompromised patients.
UPON CHECK OUT:
- There will be a screen between you and check out staff
- For credit card payments, you will be given opportunity to show staff your card (behind plexiglass screen) and sign with stylus.
- Appointments for follow up will be made at this time. We encourage you to make these appointments at this time as it might take longer when calling back.
If you have any questions or concerns, please contact us immediately.
The below links provide additional information regarding the coronavirus:
World Health Organization (WHO): https://www.who.int
Centers for Disease Control (CDC): https://www.cdc.gov
Our team will continue to monitor the situation and provide updated information when warranted. Thank you for your patronage.