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Patient Forms
Now you can fill out your patient history and registration forms before coming to the office. No more clipboards in the waiting room! Before your first visit do the following:
Step 1 Download Acrobat Reader from the Adobe website . You must have the latest version in order to fill out the forms, otherwise they will arrive blank.
Step 2 Based on your age or that of your child, fill out each the five forms below and save them to your Desktop or My Documents folder.
Adult Forms (18 years and over)
- Adult Patient Registration
- Health Overview
- Family History
- Personal Health/Immunizations
- Health Habits, Hospitalization and Trauma History
Adolescent Forms (10 to 17 years)
- Adolescent Patient Registration
- Health Overview
- Family History
- Health, Immunizations, Hospitalization and Trauma History
- Social History
Pediatric Forms (newborn to 9 years)
- Child Patient Registration
- Health Overview
- Family History
- Health, Immunizations, Hospitalization and Trauma History
- Pre-natal/Newborn Health
Step 3 Email the completed forms using the YouSendIt drop-box page. This drop box is secure and meets federal standards for privacy of medical information. Follow the instruction on the screen and just remember where you stored the completed forms. You may choose to just fill out the forms on your computer, print them, and bring them with you to your first visit. (Please note - Connecticut patients should only use the email method and should send the forms several days before their visit)
Click here if you require detailed instructions for completing and sending your forms.
If forms won't load: open your new Adobe Reader program. Click on Edit, then select Preferences from the menu. Then select Internet from the menu. Under the Web Browser Options, un-check the box that says, "display PDF in browser". This should resolve the problem.
Step 4 Read the section below as a guide to reporting symptoms. Some patient find it useful to jot down a list of concerns to bring to their first visit.
How To Report SymptomsPatients coming primarily for osteopathic care should arrive prepared to give a brief description of their acute or chronic problem as well as any past medical, surgical and trauma history.
Patients coming for homeopathic care need to consider the following:
Set aside some quiet time for reflection. Make a list of recurring issues or problems. Describe your experience with each symptom or problem complex. When did it start? What makes it better or worse? How does it vary in relation to time of day, season, temperature, activity or position? Is it related to eating, drinking, sleep, solitude or company? What do you think is the cause of the problem? What is the context – what was going on in your life when the problem first appeared? Are there symptoms that always seem to be linked together? Please describe discharges and pain in as much detail as possible.
Next consider what are called generalities. These are statements that are true about you as a person but not in terms of any specific condition. Generalities include food cravings, favorite weather, temperature sensitivity, and your favorite time of day, interests, and hobbies.
The most important information you can provide is some sense of your personality. This is often the most revealing and hence the most difficult thing for a patient to discuss. Please understand that no value judgment is made about you. There are no "good" or "bad" personalities. This information is used to generate an understanding of which remedy or remedies correspond to the totality of who you are and, therefore, which remedies are most likely to help stimulate a healing response.
If you can identify some event or illness after which your level of health was never the same, it is important to describe how things were before and after the event.
In the case of infants and children the emphasis will be on physical symptoms and generalities. Parents are asked to bring a written list of issues, problems and descriptions of their child based on their observations and not to simply ask their child for the information during their visit.
The challenge of Integral Medicine, even in the treatment of apparently purely physical conditions, is to select a few probable remedies from many possible remedies. This selection process is aided by an understanding of who you are based on your description of your mental, emotional and physical life.
