This form is for patients interested in IV Ozone Therapy, PRP, Trigger Point & Joint Injections, Hair Restoration, and Musculoskeltal Consults. If you you interested in being seen for Functional Medicine or for full medical evaluation, please return to our website and complete the Adult or Pediatric Intake Form.
We hope you will answer the questions on this medical history form as thoughtfully as possible. Please consider this an opportunity to write anything you think may be pertinent to your condition. ALL THE INFORMATION IN THIS QUESTIONNAIRE IS CONFIDENTIAL BY LAW.
If you do not have all your X-rays, MRIs, CT Scans (both images and reports), please start collecting those from other providers you have seen. They are vital in guiding you appropriately.