Insurance (only needs to be filled out for the adults, I will add it to the kids file if needed)
Covid-19 Symptoms and other Communicable Diseases
If you have any of these Covid-19 or other disease symptoms, you must cancel your appointment. Please confirm that you do not have any of these symptoms prior to this first appointment.
Cough or shortness of breath
Fever or chills in the last 24 hours
Loss of taste or smell
Feeling of unwell or fatigue
Sore throat
Nausea or vomiting
Undiagnosed rash, infection or break in the skin
Communicable infectious disease (flu, cold, measles, chicken pox, or tuberculosis)
Recent exposure to COVID-19, positive case exposure
Recent travel to areas where endemic diseases are present
Recent travel out of the country in the last two weeks, without Covid-19 PCR test upon return