COVID-19 Questionnaire-Rockland Location

Please note that entry to the clinic requires a Covid-19 screening.  We ask that you attend your appointment alone to reduce the risk of spread.

We ask that you bring minimum personal belongings inside of the clinic (e;g wallet and cellphone). Please leave backpacks or bulky items in your vehicle.

  • Do you currently have any of the following symptoms:

  • If you answered yes to any of the above questions we will need to cancel and reschedule your appointment two weeks later without penalty. It is suggested that you seek advice from your physician.

    If all answers are negative , we will make a note in Orchid and proceed with confirmation.
  • Acknowledgements