743 Carolyn Rd, Washington Court House, OH 43160
(740) 335-8877
info@levensonperio.com

Patient Registration

We want your first visit with us to be as relaxing as possible.   Please take a minute to print and fill out our Patient Registration Form and Medical History Form and bring them with you to your appointment.  If you are not able to print these forms out, not to worry, you can fill them out at the office. Please come 15 minutes prior to your appointment to leave adequate time for your paperwork. You will also be asked to fill out a Covid-19 Patient Screening Form at your appointment and your temperature will be taken as we will be strictly following the CDC and ADA guidelines.

 

 

Medical History Form

Medical History Form

L' Esthetics Is Now Open!