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    You will need to complete the next Intake and Consent forms electronically.  

    BEFORE YOU BEGIN this section, there are a few key things that will make things very easy for you, and please keep them handy.  If not, please come back to this page later and finish it:

     

    • Your COVID vaccine cards (you will take a picture and upload)

     

    • Any immunization records/labs (you will have the option to take a picture and upload, or upload a PDF)

     

    • Identification document copy (such as a passport, and you will upload or take a photo to upload)

     

    • Insurance card (you will upload a photo)

     

     

  • Immigration Physical Exam I-693 Intake

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  • TUBERCULOSIS HISTORY

  • GONORRHEA HISTORY

  • LEPROSY HISTORY

  • BEHAVIORAL HEALTH HISTORY

  • In the past, have you...

  • Review of Systems

    Please check the box if you have any of the following symptoms or else check "none."

  • Clear

  • If you are completing the PDF version of the I-693 form you have the option of uploading the completed form here.  Also, please upload or take a picture of your COVID vaccines and any vaccination records here to make the process more efficient.  You may also bring the copy to the office during your visit.

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