Step 1: Educated our workforce using validated resources such as the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), Occupational Safety & Health Administration (OSHA) and the US Department of Health.

Step 2: Evaluated our ability to continue to provide services without increasing exposure risks to our patients, visitors and staff. As part of that process, we developed a questionnaire for patients, staff and visitors that will ascertain exposure risk. The questions will be administered each visit for patients/visitors and daily for staff. The questions are as follows:

• Have you traveled to China, South Korea, Iran, Italy or Japan or any other country with high COVID-19 incidents within the past 30 days?
• Have you had any contact with anyone diagnosed with COVID-19, with any person(s) under investigation for COVID-19 or anyone with flu-like symptoms (fever, cough and shortness of breath)? The exposure could be to spouses, partners, family members, friends, work colleagues, social group members, fellow students, church members or any other person(s) or groups where there could have personal contact (within 6 feet).
• Have you had any symptoms? Fever, cough or shortness of breath in the past 14 days? If positive for symptoms we are asking the patient to contact his/her physician for guidance and written permission to attend therapy. We are also asking patients to call the clinic prior to arriving if they have any flu/virus-like symptoms.

Step 3: Intensified our housekeeping & infection control procedures to ensure minimal to no patient contact with anything or any area that could harbor harmful bacteria or viruses. Our staff is disinfecting surfaces, door knobs, weight machines, treatment tables and equipment regularly. Our therapists will gladly wear gloves during your treatment if requested. In addition, we are asking all individuals who enter our clinic to:

• Complete the Patient Coronavirus-19 Questionnaire each visit or confirm verbally no changes since last completing the questionnaire.
• Apply furnished hand-sanitizer prior to completing paperwork, signing-in for appointments, sitting in the reception area or starting treatment.
• Practice good hand hygiene (frequent handwashing) as well as good cough and sneeze etiquette (cover mouth with tissue when coughing or sneezing and deposit the tissue in a hands-free trash can or cover his/her mouth with his/her elbow if tissues are not immediately available).
• Apply furnished hand-sanitizer when departing the clinic.
• Advise care-givers to wait in their car so our reception area is less congested.

Step 4: Reconfigured our clinical area, gym and reception areas to permit greater physical separation of patients.

Step 5: Adapted our schedule to accommodate our immunologically compromised patients including, but not limited to, the frail or elderly.

The final step is to continue to educate our workforce and our patient community regarding COVID-19. We will consistently employ measures to minimize the spread of COVID-19 according to the CDC (and other credible authorities) recommendations and will keep you informed of any changes in protocols.