COVID-19 Pre-screening and Informed Consent Form
THE COMPLETION OF THIS FORM IS REQUIRED 12 HOURS PRIOR TO RECEIVING YOUR TREATMENT.
As mandated, prior to your appointment you must complete a 2 step informed consent and screening process.
This online form submission is the preliminary informed consent and COVID-19 prescreen that is required to be received no sooner than 12 hours of your appointment time. If you submit this form earlier than 12 hours from your scheduled appointment time, you will be required to resubmit at the time of treatment.
If you pass the initial screening, your second pre-screening will occur once you have arrived at the office.
If you have any questions, give us a call at 519-325-0118.