Headache Wellness Center


ALL FORMS MUST BE COMPLETED PRIOR TO YOUR SCHEDULED APPOINTMENT Our providers rely on the medical history and information you provide on these forms. This information is a key component in the evaluation and management of a treatment plan that is unique to you and your medical background. Being well prepared for your appointment will ensure that we have all the necessary information to provide the best possible care for you. It will also help reduce any unnecessary wait time that will occur due to missing information and any anxiety you may be feeling. So take some time to review our website, and meet our doctors. New Patient Forms All forms to be read and completed by new patients and patients that have not been seen for 2 years or more. Registration and HIPPA If current patient and not see in a year, update registration and HIPPA New Patient Referral Form For referring doctors use only Revisit Form Completion required for each revisit appointment Headache Calendar The headache calendar is an effective tool that helps your healthcare provider find out what may be causing your headaches. By recording when you get your headaches, what medicines you took to relieve them, and possible headaches triggers, you may begin to see a pattern over time. Your headache provider will also be able to see how well your medications are working. Therefore, it is important for you to bring these calendars with you to every office visit for review and discussion. Medical Record Request Form Legal form for requesting medical records Sleep Questionnaire Sleep Revist Form Two Week Sleep Diary

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