Avantara Norton Visitation Request
Avantara Norton is working with our local and state public health departments in order to establish outdoor visits between our residents and their loved ones. With that being said, we are excited to help arrange an outdoor visit with you and your loved one, when they become possible.

If you are interested in signing up for an outdoor visit with your loved one, please read the important guidelines below, and then complete the below with your information. These guidelines were established to safeguard every resident to the best degree possible and mitigate the exposure of our residents, staff and visitors to the COVID-19 virus.

After completing this online form and the facility has finalized all preparation, a staff member will reach out to you to help arrange a visit with your loved one.

IMPORTANT GUIDELINES

General:
• Visits are by appointment only.
• Visitation is limited to a maximum of two (2) visitors per visit.
• All visitors must be over the age of 12.
• Residents will be allowed one visitation per day. Back-to-back visits are not permitted.
• Appointments may be made Mondays and Fridays, from 11 a.m. - 1 p.m.
• Appointments will be limited to 15 minutes per visit. This will allow other families to also visit, and staff time to disinfect tables, chairs, etc.

Resident and Visitor Screening:
• Each visitor will be screened for COVID-19 symptoms over the phone by the facility representative approximately 24-hours prior to the scheduled visit and once more upon arrival to the facility prior to the visit.
• Visitors with COVID-19 symptoms will not be allowed to visit the resident.
• Visitors that have had a previous diagnosis of COVID-19 will need to bring proof that they are no longer contagious (e.g., A Dr’s note).
• The resident must also pass a COVID-19 screening prior to visitation. No symptomatic residents or COVID-19 positive residents will be allowed visitation.

Visitation guidelines:
• Visitation may only occur outdoors at the designated outdoor visitation area.
• Visitors will not be allowed to enter the facility at any time, for any reason, including bathroom breaks.
• The facility will have hand sanitizer available and each visitor is required to use the hand sanitizer prior to entering the outdoor visitation and prior to leaving.
• Please bring your own mask. All visitors are always required to wear their mask, while on the facility campus.
• Social distancing of 6-feet must always be maintained.
• No physical contact including hugging, kissing, or handshake is permitted at any time during the visit.
• No food or drink is allowed during the visit.
• Staff will supervise visitation and ensure the use of face coverings and social distancing of a least 6-feet is kept at all times.

Here is a helpful video from the CDC regarding visitation: https://tinyurl.com/Video-CDC

PLEASE NOTE: We will make every effort to ensure visitation appointments are kept. Due to circumstances beyond our control, the facility is permitted to postpone or cancel visitation for the day depending on the weather or other unforeseen situations that may affect implementation of infection control protocol.
Email address *
My loved one's full name: *
My full name: *
My relationship to the resident: *
My phone number: *
Note: this will be the phone number used to contact you if [facility name] is able to conduct outdoor visitation.
A copy of your responses will be emailed to the address you provided.
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