If you are an established patient of Breezewood Family Healthcare and haven't been seen in 2 years or more please fill this form out. This will help catch your provider up on any changes in your medical history and can reduce you time in the office.

Filling this chart out prior to all your visits will help your practitioner in providing you the best possible healthcare.

We recommend that you include all vitamins and any herbal supplements that you may be taking.

A simple tracking sheet to help document your pressures and help your provider help you in maintaining healthy blood pressures.

All new patients are required to show 30 minutes prior to their first appointment. This allows us to process your information and get your history to your provider. However, by downloading and filling in these forms prior to your visit you can greatly reduce your wait time and visit time at our office.

This authorization is for Breezewood Family Healthcare, P.A. to receive or release information being requested of you, by you in order to comply with the terms of the Confidentiality of Medical Information Act.