Mount Royal Village Family Chiropractic, Massage & Acupuncture
COVID-19 Screening Tool

Please complete and submit this form on the day of your appointment with Mount Royal Village Family Chiropractic, Acupuncture & Massage.

To ensure the health and safety of both our patients and staff during the COVID-19 pandemic, we require submission of consent in order for patients and staff to attend appointments.

All patients are required to review and submit a consent form prior to coming in for their next appointment.

PLEASE COMPLETE THE PATIENT CONSENT FORM BELOW:

*Required

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If you have any questions, please contact us at (403) 475-6210 or email us at mountroyalchiropractor@gmail.com.

Thank you from the team at Mount Royal Village Family Chiropractic,
Acupuncture & Massage!