It's important that we have all the
information needed to reach the very best decisions about your
diagnosis and treatment.
The next step enables you to become an active partner in helping us provide you the most comprehensive healthcare. The time you take now to provide securely a medical history and list of symptoms you are experiencing is crucial to assure a successful visit with your health care provider. We are now going to take your relevant history and symptoms. 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 as this is only a screening tool and cannot be completely comprehensive. Answer as accurately as you are able, and your answers will be reviewed by your health care provider prior to your visit.
Do you consent to have your information shared with your provider?
If you click "No" you
will not be able to move forward
with the questionnaire.
If you click "Yes" and
change your mind at any time
during the questionnaire, you
can abandon the survey and it
will not be submitted.