Patient Intake Forms
Patient Medical History Intake Mandatory before first appointment
Click below to get started!
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
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
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.