Pre-Screening Questions for COVID-19 v9
Please answer the following questions on the day of your appointment at Lake Washington Wellness.
Sign in to Google to save your progress. Learn more
Email *
Clients Full Name *
Has any of the following information changed since your last visit: Insurance Carrier or New Insurance Card, Credit Card on File, Contact Phone Number *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy