Welcome to Our Patient Intake Form.

We encourage you to use this secure, password-protected form to tell us about your health history prior to your first visit. This form should take no more than 60 minutes to complete, and ensures that we provide you with the best care possible. To access the form, input your email address as the Username and enter the password that you set up. If you have any issues logging in, creating a password or saving the PIF, please call our Technical Support at 1-855-564-7657 between the hours of 7:00am-10:00pm CST, Monday-Friday.