Medical History/Intake Forms - Northside Cherokee Cardiology 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information at the top of the form, including your name, today's date, and date of birth. This ensures that your records are accurate and up-to-date.
3. In the 'Current Problem' section, briefly describe your main symptoms or reason for your visit. This helps the medical team understand your needs better.
4. Proceed to the 'Cardiac Risk Factors' section. Here, indicate any relevant risk factors by checking 'YES' or 'NO', and provide additional details where necessary, such as recent test results.
5. Fill out the 'Past Medical History' section by checking any medical conditions you have had and listing any surgeries. This information is crucial for your care.
6. Complete the symptom checklist under various categories like Constitutional, Eyes, Ears/Nose/Mouth/Throat, etc., by marking 'YES' or 'NO'.
7. Finally, provide details about your pharmacy and current medications in the designated sections to ensure seamless communication with your healthcare provider.

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