Covid-19 Procedures

Check Each Statement To Attest They Are True. If you cannot check every box, we will reschedule your appointment.* Required field!

- I have not been diagnosed with or cared for someone with COVID-19 in the past two weeks.

- I have not shown symptoms of COVID-19 or come in close contact with anyone exhibiting these symptoms in the past two weeks.

- I have not traveled outside of the following states, NJ, PA, DE, NY nor have I traveled outside the country within the past two weeks.

- I do not have a cough, fever, chills, shortness of breath, or loss of taste or smell.

- If I begin to show symptoms of COVID-19 within the next two weeks, I will contact my clinician.

- I will follow all posted rules to keep myself, my clinician, and those around me safe.

Required field!

New Covid-19 Procedures