COVID-19 Intake Form

If you have selected any of the boxes above, you are ineligible for services at this time.  Please call, and we will reschedule your appointment. 

If you are considered to be high risk or having a weakened immune system, we ask that you postpone booking any appointments for the time being, until we have a better understanding of the virus and its complications, as you are at a greater risk of contracting COVID-19.