Injection Therapy Health Screening Form - purewellnessgroup ca 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the GENERAL INFORMATION section. Enter your date, name, date of birth, gender, and contact details including home, work, and cell phone numbers.
3. Proceed to the MEDICAL HISTORY section. List any current medications or supplements along with their dosage and purpose. Include details of any surgeries or injuries you have had.
4. In the MEDICAL TESTING section, document any tests completed in the last five years and their results. Also, list all allergies or sensitivities you may have.
5. Complete the sections on cardiovascular and respiratory health by checking relevant conditions that apply to you.
6. Fill out the FAMILY HISTORY section by indicating any relevant family medical history.
7. Review the INFORMED CONSENT section carefully before signing. Ensure you understand all procedures and risks involved.

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