Intake Form

Please print and bring this form with you to your first appointment.

If you cannot print it out from the website, let me know and I can email it to you. If you cannot print it out at all, please let me know at least one week before your appointment, and I will snail mail you a copy. I am asking folks to fill this out ahead of time in order to reduce the time spent in the office and thereby reduce the risk of spreading Covid-19.

Thank you for your cooperation! 

Covid-19 Liability Release

You will need to fill this out and sign it at each appointment.

Please do not fill it out before your appointment. This is meant to capture information about how you are situated on the exact day of your appointment. When you arrive, I will take your temperature and record it on the form before you sign.

Thank you for your cooperation! 

© 2019 by Koleto Wellness Group, LLC.

Katrina Koleto, LMP MA60415582

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