Our primary goal in your initial office visit is to review your health history since childhood, understanding the sequence of health care events of your life and how they may be linked, leading us to your current state of health. We will review this form and all records provided prior to your initial visit, this allowing us to have the greatest understanding of your condition. Previewing this prior to your appointment allows us more time to answer your questions and discuss treatment considerations during your appointment.
(Events and Symptoms Grouped by Decades)
Please Include:
I certify that the above information is true and correct to the best of my knowledge.
It is my responsibility to inform my physician if there are any changes in any of the information contained in this form.