At Dr. Rick Dietz–Partners in Health, PC, we offer patient forms online so you can complete them in the convenience of your own home or office. Fax us your printed and completed forms or you may bring them during your visit.
New Patient Health History Form – Required
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
Please complete ALL sections of this form that apply to you. Remember to include as much detail as possible.