A complete and accurate medical record helps assure the best care for you! Please help us keep your chart up to date by answering these questions. Since your answers may change from time to time, we will ask these questions often to be sure we have current information to guide your care.

Please complete the questionnaire shortly before your visit so the information will be as accurate as possible. When you have finished, you will see a summary of your answers.

When you arrive at the office and check in for your visit, your answers will be transferred into your electronic health record. This information will only be shared with the team members taking care of you. They will not see the information until your visit, so if there is something urgent, please call the office directly.

If you believe you have an emergency, call 911 or go directly to the emergency room. Chest pain or pressure, shortness of breath, bleeding, or thoughts of hurting yourself are examples of problems that should not wait.