Health Declaration

Please complete this prior to session:
Is your child having any symptoms of Co-Vid?
Has your child been in contact with anyone with symptoms of Co-vid?
Has your child travelled out of state in the past 14 days?

The White House Offices

7030 E. Genesee St.
Fayetteville, NY 13066
USA

Ph: 315-400-3116

ndoyle@therapysecure.com

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