Dear patient,

Thank you for taking the time to answer these questions.  It will make the time we spend together during your consultation much more effective. The information you provide will remain fully confidential.

Please do not be offended by the nature of these questions.  Since this is your first visit, we just want to make sure we have good background information.  All patients answer exactly the same quesions, we do not imply anything by asking you these questions.

Where dates are requested, estimations are always appropriate.

Some fields are required and others not.  If you do not complete a section that is not compulsory it will be assumed that you do not have a problem in this area or prefer not to address it.

We look forward to meeting you at one of our MSH Licensed Practice soon!