Patient Form
In order to optimize the time we spend with you in the office, it is very important that we capture as much information about your medical conditions and previous evaluations prior to seeing you. You may download and fill out the forms from this site for new and follow up appointments. There are also electronic patient friendly pads in the waiting room that may also be used.
New consult (first visit evaluation forms). Please don’t forget to list all of your currently taken medications. Bring any lab, xray, previous evaluation results with you. An office policy and privacy form is also included which needs to be reviewed and signed.
Click here to Download Patient Consent Form
Click here to Download New Patient Form
Note: A Portable Document Format (PDF) file requires Acrobat Reader in order to view it.Click to download Acrobat Reader.
Return visit ( after your initial evaluation). Has your medical condition changed? Any new medications? Has your insurance changed?

Click here to Download Patient Return Visit Form
Note: A Portable Document Format (PDF) file requires Acrobat Reader in order to view it.Click to download Acrobat Reader.
Patient survey. How are we doing? To serve you better, please fill out survey after your visit with us. Thanks !
Your input is greatly appreciated at Arthritis Consultants. Please complete the following form as you go through the clinic as your feedback which will help us improve our services.
NAME :
DATE (optional) :
About our telephone manners: ( circle answers)
1 Did you find the automated system easy to understand and use? Yes No
2 Do we answer your phone calls in a professional and courteous manner? Yes No
3 Were your calls to the clinic returned or requests answered  promptly? Yes No
During your visit:
About your medical receptionist:
1 Prompt and courteous service? Yes No
2 Handled the paperwork correctly & efficiently? Yes No
3 Answered all your questions satisfactorily? Yes No
About your medical aides who escorted you to the exam room:
1 Prompt and courteous service?        Yes No
2 Acted in a professional manner?    Yes No
About your:      Physician  Nurse Specialist
1 Prompt and courteous ?          Yes No Yes No
2 Knowledgeable and professional? Yes No Yes No
About our billing process:
1 Have there been any problems or discrepancies?     Yes No
2 Have your phone calls been returned promptly? Yes No

About the office:
1 Was the facility clean and well-maintained? Yes No
Overall, how would you rate the care you received from us? (Please circle a number from 1 as least satisfactory to 10 as most satisfactory )
1 2 3 4 5 6 7 8 9 10
(Least satisfactory)   (Most satisfactory)
Additional comments :
TIME of your Appointment :
TIME you arrived at clinic :
TIME escorted to exam room :
TIME that you left clinic :

 

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