All new patients please click on the link in the box below these instructions to fill out and submit our online intake form which will be submitted to us electronically..
It takes an average 10-20 minutes to complete the intake form depending upon the amount of detail in your history.
Please answer all questions completely and submit the form a minimum of 24 hours before your scheduled appointment.
1) You are not required to put in your Social Security Number and if you like this question can be left blank.
2) When entering your Birth Date enter the month and the year before the day.
3) Please enter your home address for our records even though it is not required to submit the form.
4) When answering the question for the date when your symptoms began, if you don't remember the exact date please put the first day of the approximate month that your symptoms first started. This will indicate to us that you are estimating the start date.
5) You can describe up to 4 complaints but only one at a time, so only choose only one body part and then describe the associated symptoms and you will then have an opportunity to describe additional symptom areas afterwards.
5) Please press the Submit button at the end of the form to send it directly to our secure medical records program. If you want a printed copy for your records please request this at your first visit.