• Covid Self Declaration Form

    For the health and safety of our community, declaration of illness is required. Please submit this screening promptly.
  • **If it has been two weeks since your second Covid Vaccine and you have no Covid symptoms, you can disregard this form. Please inform staff member when you check in. 

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  • If you answered yes to any of the questions, please do one of the following: 

    1. Call and reschedule your appointment 

    2. Call to switch your appointment to telehealth. 

     

  • By submitting this form I declare all of the answers are true and I am not aware of having any risk factors for Covid-19.

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