New And Established Patient Forms

If you would like to be a new patient, please use the following two forms to transfer to my office.

New Patient Registration Form click

[The registration form for Steep Falls Family Practice.]

Prior Doctor Medical Records Request click

[A form to request medical records from your prior doctor.]

If you are an established patient, use the forms below: 

Physical Exam Form  Click

[Physical examination questionnaire form.]

Depression scale

[This form is to check on your emotional well being. If you are having emotional issues, or you have not filled out this form in the past year, please click here and fill out the form and send it to the office.]