NEW PATIENT INQUIRY

 Please answer the above questions in order to assist us in determining if you are a clinically appropriate match.  In the case that we are not the best fit for you, we will try to provide you with other recommendations and referrals.  If there is a specific question that you do not feel comfortable answering, please let us know.  Everything in the questionnaire is confidential and would be shared in accordance with HIPAA and confidentiality laws.