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Home ยป COVID-19 Patient Safe Entry Form

COVID-19 Patient Safe Entry Form

  • Maison Optique Vision Center has put protocols in place for the safety of our patients and staff. Please sign below confirming that you have notexperienced any of the following:
    1. Fever within the past 48 hours.
    2. Symptoms of Fatigue, Muscle aches or Respiratory Distress in the past week.
    3. Exposure to anyone that tested positive for COVID-19 in the past 2 weeks.
  • Date Format: MM slash DD slash YYYY

We are still here for you!
Despite being temporarily closed for routine eyecare, we continue to provide helpful services for our patients, such as emergency eyeglass repairs/warranties and contact lens orders.
Please CLICK HERE for more information.
Be well!