• COVID-19 Pandemic Consultation/Treatment Consent Form

  • Arrival Policy

    I agree to wear a cloth or surgical mask upon arrival to the office and I agree to arrive alone unless I discuss special circumstances with the office.
  • Screening Policy

    I’m willing to take a temperature check and answer a brief series of questions about symptoms during my visit to the office before the services are started and I agree not to come to the office with the following symptoms of COVID-19 listed below: Fever- Temperature, shortness of breath, loss of sense of taste or smell, dry cough, runny nose, sore throat.
  •  -  -
    Pick a Date
  • Clear
  • Should be Empty: