pic

Health History

We want to provide you with the best care possible. Please complete these forms prior to your first visit so that we can be prepared for you. 

Be sure to view and download a copy of our Privacy Policies as well. 

VIEW PRIVACY POLICY

HEALTH HISTORY

 

Adult

Please fill out this Medical Intake Form if you are seeking Primary Care, Annual Wellness, or Integrative Health Services.

COMPREHENSIVE HISTORY

Child

 Please fill out this Medical Intake Form if you are seeking Primary Care or Annual Wellness Services. 

COMPREHENSIVE HISTORY

Adult

 Please fill out this Medical Intake Form if you are seeking Urgent Care or Medical Spa Services only.

BRIEF HISTORY

Child

 Please fill out this Medical Intake Form if you are seeking Urgent Care only. 

BRIEF HISTORY

THANK YOU FOR SAVING A TREE TODAY