Patient Intake Forms

Patient Medical History Intake Mandatory before first appointment

NEW PATIENTS
REGISTRATION

New Patient Agreement Acceptance
Click below to get started!

Finish
Registration

New Patients – Click below to login and continue to enter your Intake Information.

Please Complete If They Apply to You

​Chronic Pain and Headache Form

Please complete and bring to you first visit if pain is a top reason for seeing Dr. Klug.

Holistic Heart Disease Online Risk Assessment

For all new patients age 40 or older to complete and for anyone interested in a more holistic heart disease risk assessment.  

​Children's History Form

Please complete if the patient is a child and bring to your first visit.

​Medicare Private Contract Form

If the patient has Medicare, the patient or patient’s guardian must carefully read and sign this contract before Dr. Klug can see the patient. Please bring to your first visit.

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