Lititz: 717.625.2228
Lancaster: 717.735.8880
Ephrata: 717.738.0004
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Patient Forms

The following patient forms are required to be filled out prior to

your first appointment. You are welcome to print these forms and fill them

out prior to your arrival at our office. Otherwise, these forms will be provided

to you when you arrive. Please arrive 15 minutes prior to your first appointment

to complete the necessary paperwork.

Patient Intake Form (page 1)

Patient Intake Form (page 2)

Health Questionaire Form (page 1)

Health Questionaire Form (page 2)

How Did You Hear About Us (New Patients Only)

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100 Highlands Dr, Suite 100
Lititz, PA 17543
717.625.2228
90 Good Drive, Suite 201
Lancaster, PA 17603
717.735.8880
1635 West Main Street, Suite 500
Ephrata, PA 17522
717.738.0004