If you believe this is an emergency, call the OFFICE IMMEDIATELY or go IMMEDIATELY to
the Emergency Room. Symptoms such as chest pain, chest pressure, shortness of breath, or blood loss may
require immediate medical attention.
When you have a medical problem, it's important that we have all of the information needed to reach the
very best decisions about your diagnosis and treatment.
Through this questionnaire, you will be asked a series of questions that capture your medical history and
describe the symptoms of your present illness.
When you have finished, you will see a summary of your symptoms. At that time, your information
will be securely transferred to our medical office. There may be additional items that are not
asked that you may wish to mention to your physician. Answer as accurately as you are able. Your
answers will be reviewed by your health care provider prior to your visit.
Your health information is confidential and will only be shared with your provider.
Click "OK" to begin.