Skip to main content

We are OPEN and scheduling EYE EXAMS FOR THIS WEEK! Please review our COVID-19 protocols HERE.

3570 S. Val Vista Dr. Suite R-104, Gilbert, AZ
Request an Appointment
Home » COVID-19 Forms » Coronavirus Screening Questions

Coronavirus Screening Questions

  • We are currently requesting that If you marked YES to any of the above questions you please contact the office right away to discuss and/or possibly reschedule your exam for a later date. We are dedicated to providing a safe environment for our patients and staff and appreciate your understanding and participation. Please sign and return this form at your appointment.
    I attest that to the best of my knowledge the following answers are true and correct.
  • MM slash DD slash YYYY