Thank you for scheduling your annual physical exam with us. To make the process easier, we have put our physical exam forms online. Please select the correct form for your insurance.
Please note:
– If you are a new patient, we will give you the new patient paperwork at the time of your appointment
– If you are an established patient but unable to complete the form in advance, we will be happy to give you a copy in the office at the time of your visit.
– Please plan to arrive 15 minutes early when you need to complete paperwork in the office
Directions for using this page
FIRST: Please select the proper form for your insurance
SECOND: Print the form and complete it
THIRD: Bring the form with you to the office for your appointment
Please note: We will review your printed form with you at the time of your office visit. (We are unable to accept electronic submissions.)
- If you have Medicare:
1) Please print this form (Annual wellness Visit – Medicare)
and
2) Bring a full list of all current medications
Medicare requires us to include this information in your medical record. Please be sure to include your full name and date of birth; this form will be included in your permanent medical record. - If you do not have Medicare, please skip to the form below ↓
- If you have commercial insurance (e.g. Blue Cross, Harvard, Tufts, Aetna, Cigna):
Please print this form (Health History For Your Follow Up Physical Exam)
We use this form as a reference during your visit; it is not incorporated into your medical record. Please use the date of your upcoming office visit.
- Thank you!