We are currently closed to new patients except by referral, since Connie is only one person. We apologize to those we would love to see but simply cannot right now.

Welcome to our practice.
If this is your first visit with us since 2008, we will consider you a new patient even though we may already know you well. Please bear with us, also, and remind us of all the details of your history. Connie is now 50 and has been caring for a whole new community of people for the past 5 years, so may not remember all the details that would be useful to consider in your ongoing care.

We make use of extensive questionnaires for your intake and in ongoing care. We believe that the time you invest in thoughtfully completing these allows us to leverage the time in the exam room to better effect. THANK YOU FOR DOING THIS!

Please print these forms and complete them on paper.

New Patient Paperwork:

Complete Packets

Adults

New Patient Packet Adult Paper Revised 11 28 2013

Children ages birth - 12

New Patient Packet Child

Children ages 12-18

New Patient Packet Adolescent 12 18

Individual Forms:

Administrative:

New Patient Demographic And Insurance Information For Electronic Completion

Acknowledgement Of Receipt Of Notice Of Privacy Practices October 2013

Full Circle Patient Portal Informed Consent

Medical Records Release IN

History forms:

New Patient History Form Adult To Complete On Paper Revised 11 28 13

For a child (age 0 - 18):
Child History Form Updated For Completion On Paper

And add this one for children ages 12-18:
Adolescent Supplemental History Form For Paper Completion

If you have Chronic Fatigue Syndrome or Fibromyalgia, please also complete the following:

Chronic Fatigue Supplement To Clinic Intake