Please fill out the following forms on your computer.

• Save your form by selecting the print icon.
• Within the print screen select "save as PDF" in the destination drop down menu.
• Label your documents with the patient's last name. 
• Submit your forms here.

Pediatric History Form

Pediatric Thyroid Questionnaire

Thiamine Deficiency Questionnaire

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Adult History Form

We do not have an adult thyroid questionnaire at this time.  Your doctor will review all of your symptoms during your appointment.