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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.
  • Date Format: MM slash DD slash YYYY

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