Form

VIRTUAL CHECK-IN

PLEASE DO NOT FILL OUT THIS FORM UNTIL YOU ARE IN OUR PARKING LOT!

To continue to keep our lines short in our reception area, we will continue to offer online check-in.

Complete this virtual check-in with the option of either waiting in our reception room or in your vehicle.

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OFFICE - Click box #1, fill out and submit this form THEN come into our office and have a seat in our reception room. One of our team will get you when we are ready.

1. I am here and will be waiting in the reception area.

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CAR - Click box #2, fill out and submit this form. We will call you to come into the office when we are ready for you. We will also call you after the visit to give an update on treatment.

2. I will be waiting in my car, please call me when you are ready for me.

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Patient First Name

Patient Last Name

Parent/Guardian First Name (If Minor)

Parent/Guardian Last Name (If Minor)

Phone

Date

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