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Office manager handing patient forms

Please fill out a patient history form. You can chose to do a web based form (Dr. Ted’s Patients Only) or print out the form and send it in.

For Dr. Ted’s Patients

For web based health history form, click here. Please fill out form at least 2 days in advance of your appointment. It will take you approximately 1 hour to fill out. This form is on a secure server to ensure confidentiality.

Instructions to print out history form.

1. To view the history form, click here.

2. Print out the form.

3. Fill out the form and bring it into the office the day of your visit and, if possible, fax it to 1-877-857-4019 or mail it to the office where your visit is at least 2 days prior to your visit.

For Dr. Val’s Patients

Instructions to print out history form.

1. To view the history form, click here.

2. Print out the form.

3. Fill out the form and bring it into the office the day of your visit and, if possible, fax it to 1-877-857-4019 or mail it to the office where your visit is at least 2 days prior to your visit.

 
 

Secure Form Upload

This form allows for a secure upload of any pertinent lab tests, pictures, or any other information you would like to provide to our office.