Follow the steps to successfully complete the questionnaire.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Provide your full name in the designated field, followed by your date of birth, and the name of the doctor you will be seeing.
3. Fill in your sex and preferred language. Specify 'other' if applicable.
4. Provide your country and city of birth, as well as the name of your preferred pharmacy.
5. List any past surgeries along with their dates or confirm that you have no updates if applicable.
6. List all current medications, including dosages and frequency per day. Again, mark if you have no updates.
7. Identify any allergies and the corresponding reactions, or confirm that there are no updates.
8. Note any family illnesses present by filling in the relevant fields.
9. Complete the social history section by selecting your marital status and indicating any relevant information about children and living arrangements.
10. Provide information about your smoking and drinking habits, including any pertinent history.
11. Answer questions related to pregnancy and any conditions you may have experienced if applicable.
12. Finally, review all provided information, and make any necessary changes. Save your completed form for submission.
13. Upon completion, you can save changes, download, print, or share the form as required.

Complete your CA Sharp Rees-Stealy Medical Centers Patient Questionnaire online for efficient processing before your visit.