Welcome to our Check-In Portal Enter your name and mobile phone number. When we are ready for you to come in – we will text you. Patient Name* First Last Cell Phone Number*I'm here to see*Tamara Loving, MDHaleh Rajaee, MDLaura Walsh, MDLori Van Horn, MDBethanie Cooke, CPNPHolly Frankel, CPNPShellee Halton, CPNPJessica JohnsonOtherConsent* I agree to receive text messages for this service. I understand that message rates may apply and accept any charges. Covid QuestionsPlease answer the following questions.Insurance*What is your current insuranceAETNA –HMO, PPO, OPEN ACCESSANTHEM BCBS PPOANTHEM FEDERAL BCBSANTHEM HEATHKEEPERS (PPO ONLY)CAREFIRST PPO, HMOCIGNA PPO, HMOFIRST HEALTHGEHAGOLDEN RULEMAILHANDLERSOPTIMA PPO, HMO (NON MEDICAID PLANS ONLY)PHCSTRICARE SELECT (STANDARD ONLY)UNITED HEALTH CARE PPO, HMOOtherCovid Contact*Has anyone coming in for this appointment been in direct contact with a positive Covid patient / or one being tested awaiting resultsYesNoEmployment*Does anyone entering the building currently work in the medical field?YesNoCough / Allergies*Does anyone entering the building have a cough, congestion, fever, shortness of breath, or active seasonal allergies?YesNoVisitor*Who is coming into the room with the patient?CommentsThis field is for validation purposes and should be left unchanged.