Inland Orthopaedic Surgery and Sports Medicine ClinicNew Patient QuestionnaireKyle Hazelwood, MD 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information in the designated fields, including your name, date of birth, age, appointment date, sex, height, weight, and dominant hand.
3. Provide details about your occupation and referring physician. Make sure to include the address of the referring physician for accurate communication.
4. In the 'Chief Complaint' section, describe your reason for visiting. Indicate if it's a work or sports injury and provide details about the onset of symptoms.
5. Complete the medical history sections by answering questions regarding past treatments, allergies, surgeries, and family medical history. Be thorough to ensure comprehensive care.
6. Finally, review all entered information for accuracy before signing and dating the form at the bottom.

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