Before your appointment we’d like to have some information on your current and past medical history, eating habits, lifestyle and activity level. If you could, please take a second and download the form below. Then print it out and fill it in to the best of your ability. Make sure to bring the completed form to your appointment, or fax it to us at (703) 558 – 4980. Thanks much, this will make our efforts together much more efficient.

Download Medical History Form (PDF) below ⇩
Form for Women
Form for Men

If the PDF opens on-screen, rather than downloading to your computer, you will simply need to right-click on the form and choose “save as.”