• What is bothering you today?

  •  

  • (1 = mild pain, 10 = severe)
  • (1 = mild pain, 10 = severe)
  • (1 = mild pain, 10 = severe)
  • (1 = mild pain, 10 = severe)
  • (1 = mild pain, 10 = severe)
  • (1 = mild pain, 10 = severe)
  • (1 = mild pain, 10 = severe)
  • (1 = mild pain, 10 = severe)
  • (1 = mild pain, 10 = severe)
  • (1 = mild pain, 10 = severe)
  • (1 = mild pain, 10 = severe)
  • (1 = mild pain, 10 = severe)
  • PLEASE NOTE:

    For the safety of everyone in this office, we ask that you please discontinue this check-in process and refrain from entering the office until you receive a negative test result.













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