Health History Form
Note: Our intention is to serve you in a timely and professional manner, taking into account everything that potentially plays a role in what you are coming in for. The primary purpose of this form is to gather the most important information about your health. This information will be placed in your personal file that belongs to you. It is strictly confidential. This information will only be seen by your practitioner. It will not be seen by any other individual, company or agency without written consent from you, upon request. Please bring any relevant medical records, such as a physical exam, blood-work, x-rays, CT scans, etc., with you on your first visit.