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Coronavirus Information & Resources
Masks are required to enter the building. Please observe social distancing. Call ahead if you have a fever, loss of taste or smell, or have been exposed to someone who tested positive for COVID-19. See additional Coronavirus-related information.

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Forms

Expedite the check-in process by completing your forms ahead of your appointment.

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Before your appointment, download and complete your medical forms to prevent a delay in your treatment.

General Patient Forms

  • COVID-19 Vaccine Consent Form
  • PCI Health History
  • Patient Authorization & Acknowledgement
  • Medical Records Release of Information
  • Authorization to Treat a Minor

Bariatric Surgery

  • Bariatric Patient Intake
  • Bariatric Surgery Insurance Questionnaire

Bone, Joint, Sports Medicine | Orthopedics | Osteoporosis

  • Orthopedics Review of Systems
  • New Patient Form (Coester, Fabiano, Hart, Hill, Munjal, Nassif, Pape, Switzer, White)
  • Recheck Form (Switzer)
  • Back Questionnaire (Eck, Coester)
  • Hand Questionnaire (Chimenti, Kuo, Novak, Pardubsky & Fagan)
  • Bone Health History Form

Patients of Dr. Ekroth and Hill, please complete the General Health History form at the top of this page.

Ear, Nose & Throat and Head & Neck Surgery 

  • ENT Questionnaire
  • Sleep Apnea Questionnaire
  • Vestibular Therapy Patient History Form

Family Medicine

  • Behavioral Health Intake Form — Adult
  • Behavioral Health Intake Form — Minor

Hematology & Oncology

  • Hematology & Oncology Questionnaire

Imaging & X-Ray

  • MRI Screening & Safety Form

Neurology & Sleep Medicine

  • Sleep Medicine New Patient Form

Rheumatology

  • Rheumatology Questionnaire
  • Rheumatology Recheck Form

Vascular Surgery

  • Vascular Questionnaire

Urology

  • Urology Questionnaire

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