Pre-Appointment Form revised 11/2012
Print and bring the completed form to our office.

Please plan to arrive 15 minutes early to the first appointment.

Bring to your appointment:

- Medications list
- Allergeries list
- Insurance card
- Photo I.D.

On your first visit you will be asked for basic information to establish your medical record and business account. Please bring your current insurance card to this first visit and notify our office of any changes in name, address, phone number or insurance information, as soon as they occur.

Please advise staff of any X-rays, EMG testing or other medical treatment you have received for your condition prior to your visit. It would also be helpful to bring a typed or printed list of your allergies and medications to your appointment.