Covid-19 Patient Screening Test

For each appointment, you must fill out this Covid-19 form on the day of your appointment prior to gaining admittance.

Please come to your appointment alone. If absolutely necessary only one person may accompany you. Each patient and the accompanying person must fill out and pass the covid screening tool before they can proceed further.
If yes, please provide their full name and phone number.
4. Do you or anyone in your household have any of these symptoms, yes or no?