[et_pb_section fb_built=”1″ custom_padding_last_edited=”on|desktop” _builder_version=”3.23″ background_image=”https://www.bakerandgraham.com/wp-content/uploads/2020/01/Be-inTouch.png” custom_margin=”20px||” custom_padding=”8px||186px|||” custom_padding_phone=”||50px”][et_pb_row use_custom_gutter=”on” gutter_width=”1″ custom_padding=”159px||0px|||” custom_padding_phone=”50px||” custom_padding_last_edited=”on|desktop” _builder_version=”3.23″][et_pb_column type=”1_4″ _builder_version=”3.23″][/et_pb_column][et_pb_column type=”1_2″ _builder_version=”3.23″][et_pb_text _builder_version=”3.23″ text_font=”||||||||” header_font=”||||||||” header_text_align=”center” header_text_color=”#ffffff” header_font_size=”18px” header_letter_spacing=”1px” header_2_font=”||||||||” header_2_text_align=”center” header_2_text_color=”#ffffff” header_2_font_size=”5vw” custom_margin=”0px|||||” custom_padding=”17px|||||” header_font_size_phone=”14px” header_font_size_last_edited=”on|desktop” header_2_font_size_phone=”30px” header_2_font_size_last_edited=”on|desktop” custom_css_main_element=”||”]

FOR PATIENTS

Patient Disclosure

[/et_pb_text][/et_pb_column][et_pb_column type=”1_4″ _builder_version=”3.23″][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.23″ custom_padding=”||14px|||”][et_pb_row use_custom_gutter=”on” custom_padding=”||0px|||” _builder_version=”3.23″ width=”70%” width_phone=”80%” width_last_edited=”on|phone” max_width=”70%” max_width_phone=”80%” max_width_last_edited=”on|desktop”][et_pb_column type=”4_4″ _builder_version=”3.23″][et_pb_text _builder_version=”3.23″ header_font=”||||||||” header_2_font=”||||||||” header_2_text_align=”left” header_2_font_size=”3.5vw” header_2_line_height=”1.2em” custom_margin=”||22px|||” header_2_font_size_tablet=”4.5vw” header_2_font_size_phone=”30px” header_2_font_size_last_edited=”on|desktop”]

Patient Disclosure

[/et_pb_text][et_pb_text _builder_version=”3.23″ text_font=”|600|||||||” text_text_align=”left” custom_margin=”|10%||” custom_margin_tablet=”|0%||” custom_margin_phone=”|0%||” custom_margin_last_edited=”on|phone” custom_css_main_element=”font-weight:500″]

This patient disclosure form seeks information from you that we must consider before making treatment decisions in the circumstances of the COVID-19 virus.

A weak or compromised immune system (including, but not limited to, conditions like diabetes, asthma, COPD, cancer treatment, radiation, chemotherapy, and any prior or current disease or medical condition), can put you at greater risks for contracting COVID-19. Please disclose to us any condition that compromises your immune system and understand that we may ask you to consider rescheduling after discussing any such conditions with us.

It is also important that you disclose to this office any indication of having been exposed to COVID-19, or whether you have experienced any signs or symptoms associated with the COVID-19 virus.

[/et_pb_text][et_pb_text _builder_version=”3.23″][wpforms id=”1448″ title=”false” description=”false”][/et_pb_text][et_pb_text disabled_on=”off|on|on” _builder_version=”3.23″]

[/et_pb_text][et_pb_text disabled_on=”on|off|off” _builder_version=”3.23″]

[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.23″ custom_padding=”2px||4px|||”][/et_pb_section][et_pb_section fb_built=”1″ custom_padding_last_edited=”on|desktop” _builder_version=”3.23″ custom_margin_phone=”0px||” custom_margin_last_edited=”on|desktop” custom_padding_phone=”0px||”][et_pb_row custom_padding=”15px|||||” custom_padding_phone=”15px||0px” custom_padding_last_edited=”on|desktop” _builder_version=”3.23″][et_pb_column type=”4_4″ _builder_version=”3.23″][et_pb_divider color=”#9f9f9f” _builder_version=”3.23″][/et_pb_divider][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section fb_built=”1″ admin_label=”footer” _builder_version=”3.23″ background_color=”#003b54″ custom_padding=”36px||0px|||” global_module=”261″ saved_tabs=”all”][et_pb_row custom_padding=”9px||0px|||” disabled_on=”off|off|off” admin_label=”desktop and tablet footer” _builder_version=”3.23″ width=”100%” max_width=”100%”][et_pb_column type=”1_3″ _builder_version=”3.25″ custom_padding__hover=”|||”][et_pb_image src=”https://www.bakerandgraham.com/wp-content/uploads/2020/01/BG_footer-1.png” align_tablet=”center” align_last_edited=”on|phone” module_class=”footer-logo” _builder_version=”3.23″ width=”50.6%” width_tablet=”28.2%” width_last_edited=”on|desktop” max_width=”49%” max_width_tablet=”28.2%” max_width_last_edited=”on|desktop” module_alignment=”center” custom_margin=”|||||” custom_padding=”|||0px||”][/et_pb_image][et_pb_text _builder_version=”3.23″ text_font=”montserrat-light||||||||” text_text_color=”#ffffff” text_font_size=”12px” custom_margin=”|||20%” custom_margin_tablet=”|||0%” custom_margin_phone=”|||0%” custom_margin_last_edited=”on|tablet” custom_padding=”|||” text_text_align_tablet=”center” text_text_align_last_edited=”on|desktop”]

Phone 601-268-3333

Fax 601-268-6666

4216 Lincoln Road

Hattiesburg, MS 39402

[/et_pb_text][et_pb_text _builder_version=”3.23″ text_font=”montserrat-light||||||||” text_text_color=”#ffffff” text_font_size=”12px” custom_margin=”-17px|||20%||” custom_margin_tablet=”0px|||0%” custom_margin_last_edited=”on|phone” custom_padding=”|||” text_text_align_tablet=”center” text_text_align_last_edited=”on|desktop”]Office Hours:
Mon – Thurs: 8AM – 5PM
Walk-ins Welcome![/et_pb_text][et_pb_text disabled_on=”on|on|off” admin_label=”desktop social icons” _builder_version=”3.23″ text_font=”||||||||” custom_margin=”|||20%” custom_padding=”0px|||||” text_text_align_tablet=”center” text_text_align_phone=”center” text_text_align_last_edited=”on|phone”]

[/et_pb_text][/et_pb_column][et_pb_column type=”2_3″ _builder_version=”3.25″ custom_padding__hover=”|||”][et_pb_text disabled_on=”on|on|off” _builder_version=”3.23″ text_font=”||||||||” text_text_color=”#ffffff” text_font_size=”11px” header_font=”||||||||” header_2_font=”||||||||” header_2_text_color=”#ffffff” header_2_font_size=”13px” custom_margin=”9%||22px|10%||”]

ABOUT
SERVICES
FOR PATIENTS
CONTACT

[/et_pb_text][et_pb_divider color=”#ffffff” disabled_on=”on|on|off” _builder_version=”3.23″ width=”76%” min_height=”12px” custom_margin=”-19px||-15px|10%||” custom_padding=”||0px|||”][/et_pb_divider][et_pb_text disabled_on=”on|on|off” _builder_version=”3.23″ text_font=”||||||||” text_text_color=”#ffffff” text_font_size=”11px” header_font=”||||||||” header_2_font=”||||||||” header_2_text_color=”#ffffff” header_2_font_size=”13px” custom_margin=”|||10%” custom_padding=”0px|||||”]

[/et_pb_text][/et_pb_column][/et_pb_row][et_pb_row custom_padding=”9px|||||” disabled_on=”off|off|on” admin_label=”Mobile footer” _builder_version=”3.23″ width=”90%” max_width=”90%”][et_pb_column type=”1_2″ _builder_version=”3.25″ custom_padding__hover=”|||”][/et_pb_column][et_pb_column type=”1_2″ _builder_version=”3.25″ custom_padding__hover=”|||”][et_pb_text _builder_version=”3.23″ text_font=”||||||||” text_text_color=”#ffffff” text_font_size=”11px” header_font=”||||||||” header_2_font=”||||||||” header_2_text_color=”#ffffff” header_2_font_size=”13px” custom_padding=”0px|||||”]

ABOUT

OUR STORY
DR. BAKER
DR. GRAHAM
TESTIMONIALS
FAQ


SERVICES

GENERAL
SPECIALTY
PEDIATRIC
COSMETIC


FOR PATIENTS

WHAT TO EXPECT
PATIENT FORMS
PATIENT LOGIN
ONLINE PAYMENTS
FINANCIAL INFO


CONTACT

GET IN TOUCH
SCHEDULE AN APPOINTMENT
POST-APPOINTMENT SURVEY
LEAVE A REVIEW

[/et_pb_text][/et_pb_column][/et_pb_row][et_pb_row custom_padding=”9px||2px|||” custom_margin=”-12px|auto||auto||” _builder_version=”3.25″ width=”90%” max_width=”90%”][et_pb_column type=”1_2″ _builder_version=”3.25″ custom_padding__hover=”|||”][et_pb_text disabled_on=”off|off|on” admin_label=”mobile social icons” _builder_version=”3.23″ text_font=”||||||||” custom_padding=”0px|||||” text_text_align_tablet=”center” text_text_align_phone=”center” text_text_align_last_edited=”on|phone”]

[/et_pb_text][/et_pb_column][et_pb_column type=”1_2″ _builder_version=”3.25″ custom_padding__hover=”|||”][/et_pb_column][/et_pb_row][et_pb_row custom_padding=”0px||0px|||” admin_label=”footer credits” _builder_version=”3.23″ min_height=”57px”][et_pb_column type=”1_4″ _builder_version=”3.23″][/et_pb_column][et_pb_column type=”1_2″ _builder_version=”3.23″][et_pb_text disabled_on=”on|on|off” admin_label=”desktop” _builder_version=”3.23″ text_font=”||||||||” text_text_align=”center” text_text_color=”#ffffff” text_font_size=”12px” custom_margin=”-24px|||||”]© Baker and Graham 2020                        Website by BREAD[/et_pb_text][et_pb_text disabled_on=”off|off|on” admin_label=”tablet and mobile” _builder_version=”3.23″ text_font=”||||||||” text_text_align=”center” text_text_color=”#ffffff” text_font_size=”12px” custom_margin=”-24px|||||”]© Baker and Graham 2020
Website by BREAD[/et_pb_text][/et_pb_column][et_pb_column type=”1_4″ _builder_version=”3.23″][/et_pb_column][/et_pb_row][/et_pb_section]