340 VETERANS MEMORIAL HIGHWAY, SUITE 10, COMMACK NY 11725
340 VETERANS MEMORIAL HIGHWAY, SUITE 10, COMMACK NY 11725
* Please click on this waiver link. Please print and sign waiver prior to your appointment.
If you do not have access to a printer, paper waivers are available at the office *
To our Patients
Our Practitioners & Staff
Cleaning
PATIENT DISCLOSURE STATEMENT
I, the undersigned, hereby attest that:
Patient name ___________________________
Signature ______________________________
Date of treatment _______________________