Patient Intake Form
PLEASE READ!!!Welcome to our online Patient Intake Form. When prompted to choose your complaint on the body diagram, if you have multiple complaints (i.e. neck/shoulders and lower back/right leg pain) click on the body diagram for one complaint then answer the questions. The system will then ask about additional complaints. Repeat clicking on the diagram and answering the questions for each of your complaints. The information you fill in will be sent directly to our office, speeding up your office visit and allowing us to better serve your healthcare needs.