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 a questionnaire, you will be asked a series of questions that capture your medical history and describe the symptoms of your present illness. Please complete this questionnaire shortly before your visit, so that the information will be as current as possible.

You will need the following information to complete the questionnaire:

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.