This form is the basis of our meeting and is extremely important to understanding your past and current health. We spend a significant amount of our time on your answers to help us better understand how to best serve you. Please gather your medciations or have an up to date med list handy.
Our website uses SSL/HTTPS encryption and has no tracking cookies. All the information typed is secure and never stored. That is why it is important to take your time when you have 15-30 minutes to fill out this information in one session without exiting your internet browser. When typing your information, it is kept in a secure state on your computer temporarily, never stored on our server, and is transmitted securely to an encrypted HIPAA compliant email with multiple layers of protection. We strive to achieve the very best security methods.
When the form is complete you will get a green notification and an email confirmation sent. Feel free to call us at 754-999-1000 if you ever have any technical or appointment questions.