ADULT PATIENTS (16 years of age and older)
All patients 16 years and older should fill out these two forms:Food Frequency Questionnaire (Adult)
Chronological Summary
There is only ONE (1) additional form to complete -
PLEASE CHOOSE ONE OR THE OTHER, BUT NOT BOTH:IF your symptoms vary from day to day or week to week or month to month, then you should fill out this form: Adult Allergy Database & Health History
(for patients 16 years old and older)
IF you are NOT choosing the above form, then please fill out the Initial Health Survey form: Initial Health Survey for Men - 2016Initial Health Survey for Women
Please do NOT fill out BOTH the Allergy form AND the Initial Health Survey form. This will cause needless work for you. Choose one or the other, but not both! Please print each item on each form in blue or black ink, and complete and return to our office as soon as possible.
Do not use email to return these forms, it is not secure, and the quality is very poor.
Click HERE to go back to the main forms page, which has the four forms required of all patients.
We are a fragrance free office. Click HERE for more details about that, and to read our cancellation and privacy policies.
Otherwise, use the menu above to navigate our website.
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