New Patient Intake Form Packet

In order to minimize time spent in the waiting room filling out forms and to allow Dr. Weyrich to review your case prior to meeting with you, all new patients making an appointment to see Dr. Weyrich should download, print, fill out, and fax back to Dr. Weyrich at (888) 391-0414 the applicable PDF files listed below prior to your first visit (right click button to Download):


You must first decide whether you want Dr. Weyrich to do:

Please print and fill-out all that apply, in the order listed below.

Choose zero or one of the following:

Choose zero or one of the following:

Choose zero or more of the following:

Please fill-out and bring all original pages with you to your appointment.


If you do not understand any part of the any of the forms, leave that part blank and put a question mark in the left margin of the form for that question.