Get Deaconess Weight Loss Solutions Medical History Form For Initial Consultation 2019-2025

Filling out the Deaconess Weight Loss Solutions Medical History Form for initial consultation is an essential step towards receiving personalized weight loss support. This guide provides detailed instructions to help you complete this form accurately and efficiently online.

Follow the steps to complete your medical history form with ease.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online platform.
2. Begin by entering your name, date of birth, and age in the designated fields provided at the top of the form.
3. Next, fill in the primary physician's name and their phone number. This information is crucial for your medical history.
4. Indicate the date and reason for your most recent office visit. Provide as much detail as possible to ensure accurate medical record keeping.
5. In the medical conditions section, check only those conditions for which you are currently being treated, such as diabetes or high blood pressure.
6. If you have any medication allergies, list them under 'Medication Allergy' and describe the reaction experienced.
7. Document all current medications, including over-the-counter medicines and vitamins, by entering the name of each drug clearly.
8. For the questions that require a Yes or No response, circle your answer. This includes questions about various health conditions and treatments.
9. In the history of surgeries and hospitalizations section, provide details for any surgeries you have had, along with the reason for each surgery.
10. Complete the social history section by indicating if you smoke or consume alcohol, along with any drug use, and provide additional relevant health information.
11. For family history, check all that apply, and indicate the age and cause of any deaths within your family to provide a comprehensive view of your health background.
12. Finally, ensure you provide your signature and date at the bottom of the form to validate your submission.
13. Once all sections are completed, save your changes, download, print, or share the form as needed.

Complete your Deaconess Weight Loss Solutions Medical History Form online today to begin your weight loss journey.