Office Emergency Services

LDP Office #

Office Name

Office Address

Office City

Office State

Office Phone #

Is the Office Open?

Yes

No

If Yes -- Office is Open

Emergency Patients Being Seen

What is the current schedule?

Sun

Mon

Tue

Wed

Thu

Fri

Sat

By Appointment ONLY

If No - Office is Not Open

Are you planning on going to the office for an emergency?

Yes

No

What is the emergency phone number?

When are you planning to re-open?

How are emergencies being handled?

Office Emergency Services Survey