Patient History Form

1. New Patient Forms – Please print and fill out the New Patient History Form prior to coming in for your appointment to save time. If you cant fill it out ahead of time please arrive at least 15 minutes prior to your appointment.
2. X-Rays, MRI, CT Scans, Doctor’s Reports…
3. Gonstead Listings (if you are coming from another Gonstead Doctor)
4. Drivers Licence
5. Shoes you exercise in and any shoes that may be causing your problem along with any shoe inserts or orthotics you use.
6. It is always good to keep notes on your injuries as it helps in your evaluation. Try and note how it may have come on, what aggravates it, and what makes it better as this will make it easier to evaluate your condition.

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