PATIENT PRE-APPOINTMENT FORM
Due to the COVID-19 global pandemic, we ask that you complete this form prior to arriving at our office for your dental appointment with either Dr. John Mrozek or Dr. Philip Peluso.
We will NOT be able to accommodate your dental appointment without our office having received this form before your appointment.
In order to safeguard our dental office and the rest of the community, we ask that you arrive at the office wearing a face mask.