In order to ensure your safety, and the safety of our staff, we need you to complete this form 2 days prior to your appointment. 
We will confirm that we have received this form when your appointment is confirmed. 
When you arrive, you need to stay in your car and either call or text us. We will then let you know when you can come for your appointment. Please make sure to wear your mask and gloves. If you do not have a mask or gloves, we will be happy to supply them for you. 
Thank you in advance for your cooperation. Stay Safe!
Dr. Ganz, Laura, Joanne, Casey and Iwona.
If You Prefer To Complete This On Your Cellphone Just Scan or Take A Photo Of This QR Code, Fill Out The Form and Click Submit. 
 wufoo Covid Form qr-code.png
If needed here if a Free QRCode Reader for the iPhone 

© 2017 by Cary Ganz DDS