Patient Forms

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.  

​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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