(If recommended by a current patient, please state who so we can send them a token of our appreciation!)
When listing your history below, please prioritize and score their severity on a scale of 0-10 with 0 being non-bothersome and 10 being the worst imaginable. We may not have time to discuss everything in the first visit so prioritizing will assist us in addressing your most important issues during your initial visit. Please list in this format: Illness | Score | Approximate time it started Use a new line for each illness.
Please list Medication, Dosage, Frequency, and Who prescribed it.
Please list Supplement, Dosage, Frequency, and Who prescribed it.