Get Union Center For Healing Integral Pllc Health Intake Form

Filling out the Union Center for Healing Integral PLLC Health Intake Form online is an important step in establishing your health profile. This guide provides step-by-step instructions to help you complete the form accurately and efficiently, ensuring that all relevant information is captured confidentially.

Follow the steps to successfully complete the health intake form.

1. Press the ‘Get Form’ button to access the health intake form online.
2. Enter the date, your full name, and date of birth in the designated fields.
3. Provide your current address, including city, state, and zip code.
4. Indicate if it is acceptable to contact you via email by selecting 'Yes' or 'No', and provide your email address.
5. Fill in your home, work, and cell phone numbers in the appropriate fields.
6. Specify your gender and marital status, and provide your occupation.
7. List the name of the person who referred you, if applicable, along with their contact information for emergencies.
8. Enter the name and phone number of your primary care physician.
9. Answer whether you have been under the care of your primary care doctor within the last year and describe any conditions being treated.
10. Describe your main health concerns, detailing symptoms, their onset, diagnoses, and duration in the provided area.
11. Indicate what makes your condition better and what makes it worse by listing relevant factors.
12. Mention any other related symptoms, including tension areas or chronic issues.
13. Document any past trauma, surgeries, accidents, or chronic illnesses, including dates.
14. Complete the sections on allergies/intolerances, medications, and vitamins/supplements.
15. Fill in information regarding your exercise habits and dietary practices.
16. Check off any current or past medical conditions from the provided list.
17. Complete the family medical history section with relevant details about family members.
18. Ensure that you thoroughly check the general and anatomical symptoms list, marking any applicable conditions.
19. Review your answers for accuracy and completeness.
20. Once you have filled out all the required information, save changes, then download, print, or share the completed form as needed.

Complete the Union Center for Healing Integral PLLC Health Intake Form online today to facilitate your health assessment.