Primary Method

Please fill out the online forms below and your information will be stored at our local facility.

med_history patient_info

Secondary Method

If you do not want to fill out the forms online you have the option of printing the forms below and filling them out before coming in for an office visit.

ETPD Medical History Form
ETPD Patient Information Form


HIPPA (for your information)

ETPD’s Notice of Privacy Practices