Provided 24 hours prior to your scheduled appointment in a reminder email or text.  Please submit prior to your arrival .


I agree that I am not currently experiencing any of these symptoms:

  • Cough

  • Shortness of breath or difficulty breathing

  • Fever

  • Chills

  • Sore throat

  • New loss of taste or smell

Please note: Other less common symptoms have been reported, including gastrointestinal symptoms like nausea, vomiting, or diarrhea.

I agree that within the last 14 days I have not :

  • Tested positive for COVID-19

  • Knowingly been exposed to someone with COVID-19

  • Recently traveled to an area with a high infection rate. (Be aware that as of 11/21/20, 45 out of 50 states have high infection rates)

  • Been to a nursing home

  • Been in a situation (outside of immediate family) in which social distancing and mask wearing was not adhered to

If you have experienced any of the above, please reschedule your appointment at least 14 days from now