Covid Screening

Welcome! We want to make your stay as pleasant and as comfortable as possible. If you have any questions regarding your therapy session, please let us know.
  • This document contains important information about your decision to receive services in light of the COVID-19 public health crisis. Please read and fill out this form carefully and let me know if you have any questions.

  • fever
    muscle aches
    loss of taste or smell
    respiratory or flu symptoms
    shortness of breath
    sore throat
  • Consent for Treatment

    To proceed with receiving care, I confirm and understand the following (CHECK BOX in all places provided)
  • This field is for validation purposes and should be left unchanged.