New Patient Form

---

Due to COVID-19 concerns, we want to assure everyone about how we keep our patients safe: 

Minimize In-Person Contact in Office    

• New patients will schedule 1 hour per visit, and only 1 visitor may accompany a patient 
• We are only taking appointments, no walk-in

Screening Process 

• Patients may be asked several pre-screening questions by phone and again upon entry into the clinic before your visit. The temperature will be checked with a non-contact thermometer when you arrive at the Clinic for your appointment. 
• All staff arriving at the office are screened, including having their temperatures taken daily.

Face Mask: 

• Our staff will be wearing face masks and using other personal protective equipment, including gloves, gowns, other face protection, and eyewear.
• Caregivers and children older than 2-year-old are required to wear a mask or cloth face protection and keep it on for the duration of office visits. 

Sanitize Our Office: 

• The entire office is cleaned daily. 
• All rooms are wiped down fully on all surfaces between every single patient with disinfecting wipes and Lysol spray (that kills all viruses including the Coronavirus). Thank you for understanding and we assure you we are doing everything we can to make sure our office is safe for all.