Dr. Smith New Patient Forms
Before Your Visit with Dr. Smith
New Patient Forms
We’ll need the information on the form prior to getting started. Please download the form, complete it and bring it to your first visit. If you are not able to complete these forms prior to your first visit, please arrive 20 minutes before your scheduled appointment.
Please note: pregnant patients will need to fill in BOTH the Adult Health Profile AND the Perinatal Supplement Intake forms.
Youth ages 9-16 will require parents to complete the Youth Health Profile, which you can also download below.
Children ages 0-8 years will require parents to complete the Pediatric Health Profile, which you can download below.
The form is a PDF and requires you have Adobe Reader to open it. (Nearly all computers have this. If you cannot open the form, you can download it here: Adobe Reader.)
After opening the form, you can place your cursor in the text fields and type your answers. You can also click the appropriate selections to choose Yes/No, etc.
To print the form from your computer:
1. Choose File > Print or click icon in the toolbar
2. Select a Printer
3. Click Print