Medical History Forms

  • After we schedule your appointment, you will need to fill out the Adult or Child Medical History Form and send it, together with a recent photo of the patient, to your doctor. Please follow these steps.1. Click a link below to download the appropriate form.

    2. Save the form to your computer as [FirstName-LastName].PDF

    3. Fill out the form, then Save it again. Note: Your typed name will serve as your signature.

  • 4. Attach the completed form AND a recent photo of the patient to an email and then send them to your doctor, shown below.

    Most of the information needed will be gathered during your first appointment with us, so you don’t need to provide extensive information in the forms, nor send any medical or school records nor lab results, unless we request them.