New Patient Forms

Back to Health offers our New Patients forms online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader�® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.


This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

New Adult Patient Health History Forms- Required (All Patients 13 & Older)

Download & Print Form

New Adult Medicare Patient Health History Forms - Required (All Patients with Medicare as Primary Insurance)

Download & Print Form

New Child Patient Health History Forms - Required (All Patients 12 & Under)

Download & Print Form


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Please note...

While our office team is in 5 days a week to assist you, we only schedule appointments during doctor hours

Monday:

Office staff: 8am - 5pm

Doctors: Emergency only

Tuesday:

Office staff: 7:30am - 6pm

Doctors: 7:30am - 6pm

Wednesday:

Office staff: 8am - 6pm

Doctors: 3pm - 6pm

Thursday:

Office staff: 7:30am - 4pm

Doctors: 7:30am - 12pm

Friday:

Office staff: 8am - 1pm

Doctors: Emergency only

Saturday:

Office staff: closed

Doctors: Emergency only

Sunday:

Office staff: closed

Doctors: Emergency only