COVID-19 CONSENT FORM

top of page

Use tab to navigate through the menu items.

Temperatures will be taken upon arrival and filtered masks are to be worn the full duration of your appointment.

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

618-550-5262

Sign up for exclusive offers and news!

SUN. CLOSED

MON.- CLOSED

TUES.- CLOSED

WED.- 9AM-6PM

THUR.- 12:00PM–8:30PM

FRI.- 9AM–6PM

SAT.- 8AM–1:00PM

I accept terms & conditions

bottom of page