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Please click on the link below, print it, fill it out and bring to your next appointment.  This is a fillable .PDF form.

*Please fill out on the date of your appointment.*

Thank you!

COVID-19 Relaunch Precautions:


  • Please do not visit if you are experiencing symptoms including cough, fever, shortness of breath, runny nose or sore throat that are not related to a pre-existing illness or health condition, or are otherwise required to isolate or quarantine.


  • Please attend appointments unaccompanied, unless accompaniment is necessary (e.g., a parent or guardian may be necessary where services are provided to minors or elderly).


  • To prevent gathering, please do not arrive more than 5 minutes before your appointment.


  • If you are experiencing COVID-19 symptoms, you will be asked to re-book your appointment.


  • In accordance with the AHS regulations, we have to stagger appointments in order to keep social distancing rules.


  • As well, when you come in for your appointment, we ask that you pay for your appointment and fill out a COVID-19 pre-screening form prior to your appointment starting.