Medical Questionnaire

Filling out our Medical Questionnaire allows us to determine the cause of your ailment before any physical testing is necessary. This form is very comprehensive, so be sure you have a few minutes dedicated to answering all of the questions that apply to you.

We have many types of questionnaires available for your convenience. Filling out the Online Version of the questionnaire allows for the fastest results. Other versions are also available to be downloaded and printed.

Printed forms should be submitted to:

Please note: We recommend that you use the Adobe Acrobat version if you choose not to fill the form out online. Choosing the Microsoft Word version takes much longer to download and open. Acrobat Reader can be downloaded for free by following using the button on the side of the page.

	Online Version (HTML)	No download necessary	(recommended)
	Adobe Acrobat (PDF)	166 kilobytes	(recommended)
	WinZip (ZIP of PDF)	145 kilobytes	(recommended)
	Microsoft Word (DOC)	1,308 kilobytes
	WinZip (ZIP of DOC)	152 kilobytes