New Patient Intake Forms
Are you a new patient? Create an account to get started!
Not interested in setting up an account? No problem! You can download the patient intake forms below. The forms can be filled out electronically or printed and filled out by hand. Please email your completed form to firstname.lastname@example.org or bring a printed copy with you at the time of your next visit.
These are confidential health assessment questionnaires that are designed to provide insight into your health, family history and lifestyle. The questions will assist us in providing you with the best possible care and in understanding the factors that may be playing a role in your health.
The questionnaires are not designed to give a medical diagnosis. They will identify the current strengths of your health, and any risk factors that might be present.
Looking for extra resources? Check out our handouts for useful information and questionnaires.