Before receiving treatment, we would like to request the following information from you in accordance to safe guidelines from Public Health, our regulatory College, and the government. We appreciate your candor, time and understanding.
(Please note: a weak or compromised immune system, including from diabetes, asthma, chronic obstructive pulmonary disease, or any other issues with your lungs, cancer treatment, radiation, chemotherapy or any prior or present medical conditions, may put you at a higher risk of contracting COVID-19. We may advise you to consider rescheduling your appointment to a later, safer date.)
It is also very important that you disclose to this office any chance of having been exposed to COVID-19, or whether you have or are experiencing any signs or symptoms associated with the COVID-19 virus. It is for your health and safety, and that of our staff.
You will also receive a copy of the completed form in your email.
* Required.