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Complete your quick new patient questionnaire to confirm your appointment and experience the Ways2Well difference!
1 OF 22
Smoking Status
2 OF 22
List of Allergies & the reaction that each one causes
3 OF 22
List of Current Medications/ Suplements
4 OF 22
Family History
5 OF 22
Explain Family History
6 OF 22
Do you drink alcohol?
7 OF 22
Do you currently have or have had any of the following?
8 OF 22
Explain the history of any checked illnesses
9 OF 22
Are you increasingly stressed?
10 OF 22
Do you have headaches/migraines?
11 OF 22
Have you noticed increased belly fat?
12 OF 22
Do you feel tired?
13 OF 22
Have you noticed any changes in your sexual performance?
14 OF 22
Do you tire easily with physical activity?
15 OF 22
Do you find it hard to recover after physical activity?
16 OF 22
Do you put on weight easily?
17 OF 22
Do you get adequate sleep?
18 OF 22
Do you feel anxious, nervous, or irritable?
19 OF 22
Do you have trouble concentrating?
20 OF 22
Are you depressed?
21 OF 22
Have you lost muscle mass, tone, and strength?
22 OF 22
Do you have any bone or joint pain?
