Pre-appointment check-in

Thank you for submitting this form within 24 hours of your appointment.

It is confidential, and it brings great peace of mind to me when I get your email because *I* know that *YOU* know that you have an appointment coming up real soon. And if we have differing opinions about which day or time your session is, it can get sorted out beforehand!

First and Last Name *

Appointment Date *

Email *

Appointment Time *

Phone Number (digits only) *

1. Masks are currently optional. If you would like me to take extra precautions for your appointment, please check any options below so I can be ready for you.

Please wear a mask for my appointment
Please provide a KN95 for my appointment
Please provide a surgical-style mask for my appointment

2. Have you been experiencing cough, runny nose, congestion, or sore throat? If these symptoms are ongoing/seasonal allergies and you are negative for covid, masks aren't necessary. If these are new symptoms let me know below and we can discuss. Here is a symptom comparison chart: https://www.nia.nih.gov/health/infographics/it-cold-flu-or-covid-19 *

No
Yes, ongoing symptoms, negative for covid.
Yes, new symptoms. Please let me know details below, or call/text/message me to discuss.

Appointment booking from a distance!

(Required) *

I affirm that my responses to the above questions are true and accurate to the best of my knowledge, and if any symptoms develop before my appointment, I will contact Liz right away to discuss the options.

Phone