This form helps us have a better understanding of your condition. If filled out ahead of time, it can be reviewed prior to your first appointment.
This form can be filled out ahead of time, or please arrive 15 minutes prior to your first appointment to complete. Also, please let us know if, at any time, your address or phone number changes and we will update your profile in our records.
Please sign and complete this form prior to being seen by Dr. Reecer or Julie Risley. Also, please note anyone you authorize to have access to your health or financial information.