New Patient Forms

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! Print this out, complete it, and bring it with you to the appointment, please.

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. Print this out, complete it and bring it with you to the appointment, please.

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. Print this out, complete it and bring it with you to the appointment, please.