This is the form we read before your 90-minute first visit. The more you can fill in, the more time you'll have in the room with your doctor — instead of re-explaining the basics. Save your progress at any time, takes about 25 minutes to complete.
Tell us, in your own words, what's bringing you in. Don't worry about clinical language. We work from how you describe it.
A quick checklist. Mark anything that applies, and we'll go deeper on it in the room.
Bring the bottles to your visit if it's easier — but listing what you can ahead of time helps us prepare. Include anything taken in the last 6 months.
If you've had labs in the last 18 months, attach them here. We can request records on your behalf — but if you have access to MyChart, MyQuest, or a patient portal, downloading the PDFs and uploading is the fastest path.
PDF, JPG, PNG · up to 25MB total · or skip and we'll request records
A quick honest snapshot of how you live now. Not a place to perform a healthier version of yourself — we just need accurate baseline.
Rate the following on a 1–10 scale (10 = severe / constant). These help us calibrate where to start.
Optional. Skip if not applicable, or fill what feels relevant.
Pick a doctor and a window. We'll confirm by email within one business day.