Medical History Information

Why are you asking about my health history before my appointment?

You have been asked to tell us more about your health history because you live more than 2 hours away from our office. It is important for you to answer all of these questions honestly and completely so that we can safely provide you medical care at our clinic.

There are three different ways you can give us your health history information:

  • You can complete the form below and submit the information through our website
  • You can click here to open a PDF file, complete the form and then email or fax the form to us
  • You can call us and answer the questions over the telephone- please note this can take 5-7 minutes and you may have some wait time to speak with a staff member

Form for Online Submission:

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