COVID - Form - Gateway to Solutions

At Gateway to Solutions, we value every client's physical and mental health. We are doing our best to help keep everyone safe by following the guidelines and recommendations of the New York Department of Health and CDC.

We are ready to offer in-person sessions. Gateway to Solutions is requiring that every person be assessed for COVID-19 symptoms and risk factors each day before entering our building. Please complete the following health screen for you and anyone who is entering the building for each visit. Please complete this short survey on the day of your scheduled appointment prior to your arrival.

Please know that while in you are in the waiting room, we ask that you wear a mask and sit 6 feet apart from any client in the waiting room. Our appointments are always by appointment only---this reduces any crowded traffic in the waiting room. If you feel more comfortable, please come to your session right on-time or wait in the common hallway until your appointment time.

The office is professionally cleaned every night, has signage, hand sanitizers, and HEPA/UV-C filtration filters in all therapy rooms as well as the waiting rooms. All therapy offices also have windows for cross ventilation.

Of course, video/telephone sessions will always remain an option but for those ready to come back to session, we are ready.

If you feel unwell, we ask that you stay home and opt for video/telephone sessions.

Thank you for your cooperation!

The Team at GTS

First Name *

Last Name *

Email *

Please select your mental health provider

John P. Carnesecchi, LCSW, CEAPMadeline Weinfeld, LMSWMariam Hager, LMSWAntoinette Bonafede, LMSWCaroline Brown, LMSW

2. Have you had a positive COVID-19 test in the past 14 days?

YesNo

3. Have you or someone you live with been in close contact with someone who has confirmed or suspected COVID-19 case in the past 14 days?

YesNo

4. Have you been mandated or advised by a government agency or a physician to isolate or self-quarantine due to personal illness, illness of a close contact, or due to travel to a hot spot, in the past 14 days?

YesNo

5. Agreement5. If you have symptoms and you do not get tested, you should not return until it has been at least 10 days since your symptoms first appeared, and at least 3 days (72 hours) after resolution of fever without fever reducing medications or you have received AT LEAST 2 negative COVID-19 tests collected at least 24 hours apart and your fever has resolved without fever reducing medications. If you have tested positive for COVID-19, you must notify us, and we are required to report the positive test to the New York State Health Department and the New York City Department of Health and Mental Hygiene. You must self-quarantine for 14 days and obtain a negative test before returning. If you have been exposed to a close contact with a confirmed or suspected COVID-19, but are not symptomatic, please call your mental health provider at Gateway to Solutions to discuss your situation. If you have become sick while at Gateway to Solutions - 111 Broadyway, 9th floor, Suite 905, New York, NY 10006, you agree to immediately notify your mental health provider. IF YOU HAVE ANSWERED "YES" TO ANY OF THE QUESTIONS ABOVE PLEASE LET YOUR THERAPIST KNOW YOU WILL HAVE A VIDEO OR TELEPHONE SESSION INSTEAD OF AN IN-PERSON SESSION. BY COMPLETING YOUR NAME AND DATE BELOW, YOU AGREE TO THESE TERMS AND CONDITIONS.

Date of AgreementToday's Date