The FAIRLESS HILLS HEALTH CENTER offers our patient form(s) online so you can complete it in the convenience and comfort of your own home or office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Case History Form - Required
This let's us know the history and current state of your health. It is required for all new patients, unless you were involved in an automobile accident or a work injury. If that is the case, you would need to fill out one of the forms below.
Personal Injury Questionnaire - Required if you were injured in an automobile accident
This let's us know the history and current state of your health. It contains all of the detailed information we will need regarding your specific automobile injury.
Work Comp History - Required if you were injured at work
This let's us know the history and current state of your health. It contains all of the detailed information we will need regarding your specific work injury.