Personal Health History Questionnaire
* This document has been secured with a HIPAA-compliant asymmetric encryption algorithm to guarantee the confidentiality of your health information.
Filling out this form as completely and thoroughly as possible will ensure that your consultation with Dr. Lonsdorf will be efficient and beneficial. This usually takes about 20-30 minutes. Please have your health information, medications and supplements handy when you sit down to fill it out.
Please complete it at least 3 full days prior to your consultation, so we can enter the information into your electronic health record and Dr. Lonsdorf has time to review it ahead of your session.
* NOT FULLY COMPATIBLE WITH FIREFOX WEB BROWSER *