Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.

  • Acknowledgment of Receipt of Policy

    I acknowledge receipt of this SICK LEAVE POLICY from Michael Cohn O.D. PLLC, and I have read its contents.
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.