Health History Questionnaire

Completing this Health History Questionnaire now will save you time at your appointment. To ensure your privacy, this information is transmitted using the latest security measures.

There are nine pages. Most patients complete the questionnaire in 30-45 minutes.

After choosing a user name and password, begin answering the questions. You may stop periodically (be sure to save the form) and return to it later.

Once started, you have access to the form for 14 days.


(800) KARMANOS |
Updated: 6/2012
Health History Questionnaire