COVID-19 alert
CORONAVIRUS DISEASE (COVID-19) - UNITED STATES
OUR OFFICE IS TAKING SERIOUS PRECAUTIONS TO HELP LIMIT THE SPREAD OF COVID-19 OUT OF RESPECT FOR OUR IMMUNOCOMPROMISED PATIENTS, WE REQUIRE THAT EVERYONE WEAR A MASK WHEN COMING INTO OUR OFFICE.
EVERYONE'S TEMPERATURE WILL BE TAKEN BEFORE ENTERING OUR CLINIC. YOU WILL BE ASKED TO FILL OUT A COVID-19 QUESTIONNAIRE.
IF YOU HAVE ANY SYMPTOMS OF COVID-19 OR HAVE RECENTLY TRAVELED OUT OF THE AREA, PLEASE CALL OUR OFFICE @208-529-9292.

COVID-19 PANDEMIC - PATIENT DISCLOSURES

This patient disclosure form seeks information from you that we must consider before making treatment decisions in the circumstances of COVID-19.

A weak or compromised immune system (including, but not limited to, conditions like diabetes, asthma, COPD, cancer treatment, radiation, chemotherapy, and any prior or current disease or medical condition) can put you at great risk for contracting COVID-19. Please disclose to us any condition that compromised your immune system and understand that we may ask you to consider rescheduling treatment after discussing any such conditions with us.

It is also important that you disclose to this office any indication of having been exposed to COVID-19, or whether you have experienced any signs of symptoms associated with the virus.

Contact Us

No

I fully understand and acknowledge the above information, risk, and coutions regarding a compromised immune system and have disclosed to my provider any conditions in my health history which may result in a compromised immune system. By signing this document, I acknowledge that the answers I have provided above are true and accurate.