Medical History Form

This can wait until AFTER our inquiry phone conversation.

When your first true appointment (not an Inquiry Phone Call) is booked, you will be asked to complete the medical history form.

• For most people – you will be sent an email with a link to the secure form online.

• You can use the paper version instead, if you prefer. You can print it out (see below) or we can mail it to you.

It is so very important to know your situation and your background well.

To help with that, I find a medical history form to be invaluable.

This form is extensive and will take some time for you to complete. There may be a fairly long story to tell and many important comments and details. You are welcome to bring in several pages of notes if that would be helpful.

The history form is offered as a way for you to get much more value out of your first appointments. Yes, it does take time to fill it in and that can be tedious. Realistically, it would take even more time for me to ask you each of the questions, give you time to think through your responses and then record all the answers step by step.

The process of finding out about you and your life is something that I love to do – it is a very interesting and pleasurable way to spend time together. However, I don’t want to spend our time together with me focusing on recording all the extensive info that is needed. We will still talk extensively about your history and your concerns. It’s just that the process of taking it all down as notes is very time consuming and detracts from the real job at hand.

I would like you to receive as much “usefulness” out of each visit as possible, and using a history form is one of the best ways to improve the usefulness of the time we spend together.

So, as boring as it may seem, the purpose of the history form is to save you both time and money. Please be prepared to spend a chunk of time when completing the history form. You will get the most value from it by filling it out at least a day in advance, which will give your mind a chance to reflect on your answers. People often report that in the process they recall things they had forgotten about. You may arrive at new insights or new questions.

Online Form:

  • You can complete the history form online on your computer/laptop (does not work as well on mobile devices).
  • Since there is quite a bit of text to write, this is much easier to do with a physical keyboard, rather than using a screen keyboard such as with most mobile devices.
  • When your first appointment is made, you will be sent an email with the link.

Please be sure to complete this ahead of time. It asks for quite a bit of information (and thought) and you will not be able to get the best use from it without budgeting at least half an hour (most people are best with longer than this).

Please do not plan to arrive at the office and then complete the form. The office is not set up to have people arrive more than a few minutes before their scheduled appointment.

Paper Form:

You can print the form at home and write on it. Or, a form can be sent to you by mail or by fax.

Click to print  –>  Medical History Form PDF.

  • This will open as a separate web page with a PDF that you can simply print out using your printer at home.
  • Please print out as single-sided pages, rather than double-sided.
  • Some people like to use their computer to write some of the longer bits of their answers, and print that out to bring in, as well.

There is no need to send it or bring it to the office ahead of time – just bring it to the office with you when you come for your appointment.

Please do not plan to come to the office and then complete the form there. The office is not able to accept people arriving for their appointments more than a few minutes before the appointment time.

For visits by phone or by video link – we will discuss at your first Inquiry Phone Call how you would like to do the history form. We will need it either completed online OR have the paper version received in the office before the first appointment. Completing the on-line version of the form will probably be the best choice for most people who are not coming to the office in person.

Information From Your Medical Records

  • There may be recent lab test results, medical investigations, reports from consultations with specialists, etcetera that would be important to share with me.
  • Please consider bringing copies of these to your appointment.

This step can wait until after our Inquiry Phone Call.

If you do not have copies of these that you can bring in, you have two options.

  1. One choice is that you can request copies of lab test results and other medical reports, and then bring them with you. If you are signed up with the medical labs to view your lab reports online, please print out you lab results and bring the pages for me to keep.
  2. The other option is that you can ask your doctor’s office to forward copies of your medical documents directly to my office. This would usually be done by fax (see fax number at the bottom of the page).

Your doctor’s office will not send your medical information to me without your permission.

  • your doctor probably has a form they would ask you to sign, ask them first.
  • if not, you can print out the page below, which is a Medical Release Form. When you talk to your doctor’s office, you can take or send this form.

If you are intending to take or send this form to your family physician’s office, please be sure to speak with them about it. 

Medical Records Release Form

This link is to a PDF file. If you click, you will see a page that you can print out.