Richland Eye Care is following the current recommendations of the CDC:
I understand that I am required to wear a face covering to my appointment.
I understand that my temperature will be taken with a non-contact thermometer upon entering Richland Eye Care.
I understand that I must arrive unaccompanied (unless patient is a minor), and anyone with me must wait outside of the office for the duration of my appointment.
I understand that failure to wear a face covering or refusal of temperature measurement will result in appointment cancellation.
I have answered the health questions above honestly and to the best of my knowledge. I understand that Richland Eye Care, its doctors, and staff are taking precautions to limit any potential exposure I may have to the COVID-19 virus. I also understand that there is no definitive way to eliminate potential exposure by one hundred percent.
Signature: ____________________________________________ Date: _____________
Digital Forehead Temp: