Please fill out the text and check the appropriate box of your health information for electronic records
Please correct the errors described below.
Have you had any of the following done to evaluate the cause of your symptoms?
***IF POSSIBLE, WE WOULD GREATLY APPRECIATE YOU FAX TO OUR OFFICE ANY PERTINENT MEDICAL RECORDS IN ADVANCE, IMMEDIATELY AFTER YOUR VISIT, OR SIGN A RELEASE OF MEDICAL RECORDS FOR THEM. Fax: 305-598-0668
PAST MEDICAL ILLNESSES
Please be certain to include birth control pills, hormones, and ALL non-prescription medications, such as anti-inflammatories (i.e. aspirin, Advil, Motrin, Aleve, ibuprofen), acid blockers (i.e. Zantac, Pepcid, Tagamet, Prilosec OTC), topical hemorrhoid creams (i.e. Anusol, Preparation H), vitamins, and herbal supplements.