Dear Patient, Please fill out this questionnaire to the best of your ability. This might take about 10-15 minutes to fill out but it will ensure a much faster appointment with us since we can enter this information into your chart before you come, get your medical records from your referring physician well in advance of your visit and we can verify that your insurance is active. The safety and security  of your information is very important to us and we use the highest levels of security measures in the industry to ensure that we are HIPAA compliant. We look forward to taking care of you.


You can also request an appointment online using our APPOINTMENT SCHEDULING PORTAL. Just click on the link below.

 

You can send documents pertaining to you medical records to the following email address. You information will remain secure and confidential in your chart.

info@boladclinic.com