COVID-19 Screening Form

Susannah Graven LMT

Please correct the errors described below.

Effective May 1, 2020, all clients must complete this COVID-19 screening form.

Please answer the following screening questions:

If the answer is “yes” to any of these questions, please call your health care provider and do not book an appointment at this time.

Your typed name above indicates a "no" answer to all these questions

After you click on the submit button below, you will be returned to this page where you can click here to go to PAYPAL to pay for your appointment.

Your information will be encrypted.