|
Please note that beginning July 1, 2005 patients will be asked to fill out a form at every office visit (*see noted exceptions below). These forms gather important information concerning your medical history and current physical condition, and allow us to keep emergency contacts and insurance information up-to-date.
For your convenience, these forms are available below. Please print and fill out the forms before your appointment and present the completed forms to the receptionist when you check-in for your scheduled appointment. If you choose not to fill the form out before your appointment, you will be asked to do so when you check-in.
Please print the form and fill it in by hand.
- If you are a new patient to our practice, an existing patient that has a new condition, or an exisitng patient that has not been seen in a year or more, please fill out both the Patient Information Form (PDF- 122 KB) and the Medical History Form (PDF - 1341 KB).
These Forms can be filled out online and then printed.
- If you are coming in for a DexaScan, please fill out the Bone Densitometry History Form (PFF - 134 KB). Please print the form and fill it out by hand.
This form can be filled out online and then printed.
- If you are returning to our office for a follow-up visit, please fill out the Follow-up History Form (PDF - 1,037 KB).
The Follow-Up Histpry Form can be filled out online and then printed.
* You do not need to fill out a Follow-up History Form if you are returning for a series of 3 injections, i.e. cortisone, hyalgan, or epidural blocks.
click here to download Adobe Acrobat Reader
Site Last Updated: 29-Apr-08
 Email Me To A Friend!
|
