We are going to have our patient evaluation/intake sheets here, so that the new and follow-up patients can fill out the data in the privacy of their own homes.

At this time, we scanned existing forms, and while they look terrible, they might work until we can get the programming accomplished. With the best of intentions, we are working on this page. When done, it should save everybody a lot of time and improve the evaluation process.

Steps to completing forms:

Step 1: Open each form by clicking on it.

Step 2: Print the forms

Step 3: Complete the form

Step 4: Fax the completed forms to our office prior to your visit or bring them with you.

Fax:  407-678-7246

Intake Information:

• Health History PDF
• List of Supplements
• List of Medications
• Privacy Form PDF

David S. Klein, MD, FACA, FACPM, FACMIMS
Medical Director, Stages of Life Medical Institute
www.suffernomore.com

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225 West S.R. 434 Suite 205 | Longwood, FL 32750 | Phone: (407) 679-3337 | Fax: (407) 678-7246

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