15 N. PRESIDENTIAL BLVD, SUITE 301 s BALA CYNWYD, PA 19004
(610) 667-6161 s WWW.BALASURGERY.COM
In the continually evolving COVID-19 crisis, we are complying with all protocols to ensure the health and safety of our patients and staff, following the CDC, ADA and PA Department of Health recommendations. All patients are required to follow specific guidelines. Please complete the following form NO EARLIER THAN 48 HOURS PRIOR to your scheduled appointment. Thank you for your cooperation and understanding.