Click this link to open: Adult Health History Form
If you have booked an Initial Consultation, please print out a copy of the Health History Form and fill it out as completely as you can, before coming to your appointment. This may take 30-45 minutes, and if you don’t do it ahead of time, you will lose valuable one-on-one consultation time during the visit, filling out your form!
And remember: Please bring the form with you!
- If you have other important medical information you think is relevant, please bring it also – but do not bring X-rays or scans, as these will not be useful. What is valuable, if you have had imaging done, is the Radiologist’s interpretive report of findings, and your referring physician’s follow-up report or notes to you. Recent blood tests are very useful; please bring a copy to leave with me if you can.
- If you take numerous medications and/or supplements, the form I’ve provided only has limited space. Feel free to list these on a separate sheet, with the name of the medication, prescribing physician, reason for use, and current dosage. You do not need to list medications you no longer take, unless you feel it is relevant to your current status.
- If a physician or other health professional has referred you, please bring contact information for that provider, so that (with your permission, and if appropriate) I can send progress reports efficiently. (email address, street address, phone number) or collaborate in whatever way will benefit you.
Please come to your appointment on time — and if it is your first visit, allow a bit of extra time to find the location and handle a few preliminaries. The address is: 3881 N Longfellow Ave, Tucson, AZ 85718. (This is near River Road and Pontatoc, just east of Alvernon.) Please have my number in case you have any difficulty: 520-401-9796.
Note that failing to cancel any appointment without providing 24 hours’ notice will result in a charge for a missed appointment. Most of the time, this will be the full cost of the session, as I do no “double-booking” and will not have anyone else waiting that could see me at your scheduled time. (True emergencies, such as extreme illness, accidents or a death in the family will, of course, be exceptions. “Grey” areas will be handled through mutual agreement.) Whenever possible, 48 hours’ notice or more is appreciated, as I can try to move someone from the waiting list to the spot you’ve vacated. Thanks for your help and cooperation in making this work for everyone!