To better serve our guests and protect our staff during the COVID-19 pandemic, we request that you fill out the questionnaire below. We appreciate your cooperation and look forward to seeing you soon!

Appt COVID PreScreen

  • Personal Information

  • Date Format: MM slash DD slash YYYY
  • Health Screening

  • Please check the boxes below if you have had ANY of the symptoms listed below in the past 2 weeks.
  • Contactless Payment Options

    For guests who currently have a credit card on file with us, we now offer the option for contact-free payment. With this option we will run your card the day of your appointment and send you a digital receipt via email. If you select this option and do not have a credit card on file with us yet, or think your card on file may have expired, please call us immediately to update your account at 309.693.9600.
  • Please select your preferred payment method for your upcoming appointment.
  • Consent and Acknowledgements

  • I acknowledge that I consent to treatment at Senara and agree to any treatments that I may receive with their associated risks. I confirm that the information provided in the pre-screen questionnaire is accurate at the time of completion. I agree to notify Senara staff and/or medical professionals to any change in my condition or answers to these questions prior to my appointment time. I hereby assume all risks, hazards and costs of care or expense associated with or which may arise from such treatment, hereby releasing the personnel and consultants and any sponsoring health care facility or institution and its affiliates and all of their agents and employees from any liability from said procedure except where such risks and hazards are the proximate result of gross negligence. This constitutes the full disclosure and supersedes any previous verbal or written disclosures, advertising or marketing materials prepared by us or other.
  • Please click submit to complete your registration.

    Note: DO NOT DOUBLE CLICK or click multiple times to avoid possible duplicate charges.
  • This field is for validation purposes and should be left unchanged.