Thank you for completing these forms in advance.

Please download, print and complete the new patient information and the medical information forms. 

If you are peri-menopausal or menopausal and are coming in for a hormone consultation, please also download, print and complete the Hormone Symptoms Questionnaire.  Please bring in the completed forms to your visit.

 

New Patient intake Form

 

The New Patient Intake Form helps us get the vital information we need to create a new chart for you. We also need to know how to contact you, email you and maybe even send you a real letter with a stamp one day!

Medical History Form

The Medical History Form is our first chance to learn about your medical history, your new and old problems and all about your symptoms. We want to know the main reason you are coming in to see us. Please also include all your current medications, supplements, allergies, all the surgeries you've had. You can also write down your top three questions for the doctor to be sure we address them at your visit.

Hormone Symptom Questionnaire

The Hormone Symptoms Questionnaire is for those who believe they may be starting the transition from regular monthly periods to the peri-menopause and then menopause.  As the ovaries start thinking about retirement, we want to know all about your hormonal symptoms.  The questionnaire is arranged to help you understand which hormones are responsible for which symptoms,