Please print, fill in and sign the applicable forms below:

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Anyone entering the facility are REQUIRED to wear a FACE COVERINGNO EXCEPTIONS. If you do not have one we will provide you with one. 

If you or the person accompanying you to your appointment are experiencing any flu like symptoms, fever, acute respiratory illness, sorethroat, recent difficulty breathing, etc. or have recently traveled internationally, we kindly ask you to reschedule your appointment. 

We are requesting any person(s) accompanying you to your appointment to wait for you in the car, unless the patient is a minor or requires the assistance of a caregiver.