Providing our specialists with specific information before your appointment refreshes our minds concerning your case and allows us to customize your care. We have made that as convenient as possible by making the various forms we use available to download.
New Patient Forms
If you have not seen one of our medical doctors within the past three years, it is necessary for you to complete our “new patient forms.” To save time at your next appointment, download and print the forms. Please fill in the blanks and bring them with you to your next office visit.
Existing Patient Forms
If you’re an existing patient and have not seen one of our medical doctors within the past three months, then it is necessary to complete our “existing patient form.” You can download these forms, print them, and fill in the necessary information. Please bring the completed forms with you to your next visit to our offices.
Physical Therapy Forms
Prior to your visit with Dr. Samantha Stolper, please download the proper physical therapy forms, so Dr. Stolper can customize your care to meet your unique needs. Print the forms, fill in the necessary information, and present them to our receptionist when you arrive for your appointment.
Allergy Intake Forms
If the purpose of your visit with us is related to allergies, please download our allergy intake form, print it, provide the necessary information, and bring it with you to your allergy appointment.
Authorization For Release Of Medical Records
In some instances, we may need you to authorize the disclosure of information from your health records for insurance or other purposes. If prompted for a release of medical records, please download the form, print and complete it, and then bring it with you for your appointment.
Food/Diary Consumption Form
For various diagnoses, we sometimes ask our patients to record everything you eat and drink, including water. If you have been asked to do this, please download the form, print it, and use it to record the information we need. Where possible, note key ingredients, such as salt/sodium content, especially when you notice a change in your vestibular symptoms soon after your meal. Bring the completed form to your next appointment for analysis.