Welcome to Christine Meyer, MD and Associates! We are honored that you have chosen to partner with us for your health.
As a new patient, we invite you to tell us about you! This new-patient questionnaire will allow us to build a comprehensive medical chart for you, so we start off strong. We know it is a lot of questions, but take your time and tell us your health story. We're listening.
This questionnaire will take about 20 minutes. It is a HIPAA-secure form. You cannot pause and come back later to finish, so take a few minutes to gather any documentation you may need for the details, including:
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Medical insurance cards, if you have insurance
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Preferred local pharmacy name and Location
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Mail-away pharmacy name and Location
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Emergency contact name, phone, and address
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Medical conditions you have
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Chronic conditions you have
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Other healthcare providers or specialists you see (name and most recent visit)
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Dates of your last: physical exam, colonoscopy, and blood work
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Dates of your last: flu shot, Pneumovax, Prevnar, Tetanus, Shingles vaccine, and any other vaccines
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Surgeries, hospitalizations and ER visits
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Medications you currently take
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Allergies
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Family history (immediate family members who have relevant conditions)
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Females: Date of last period, Pap smear, gyn exam, mammogram
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Males: Date of last PSA screening and prostate exam
Click below to get started, and contact us if you have any questions.