Please print out these forms, fill them in, and bring them to your first appointment

Please do not print the forms on both sides of the page.

General Health History – these are the forms needed by most patients

Women’s Health History – women who are seeking treatment for infertility, menopause, menstrual problems, or other hormonal issues should fill out this form set

Pediatric Health History – please fill out these forms for patients age 14 and under (patients over the age of 14 should fill out the general form above)

Addiction Health History – patients who are seeking treatment for smoking cessation and other addictions should fill out this set of forms


You will need Adobe Acrobat Reader to download and print your forms. If you do not have Adobe Reader, you can get it here:

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