California Pre-Assessment Questionnaire

All information submitted is confidential and secured via HIPAA-compliant encryption. Please answer all questions completely and truthfully. We wish to allocate and plan resources most suitable for your needs, thereby avoiding downstream delays or disruptions in your care. Please refer to your prior records, medications, and our practice website for additional information. Before we establish care, we ask that you complete a Pre-Assessment Questionnaire (PAQ) or Prospective Patient Questionnaire, which will guide our administrative team in determining your level of care and help us plan your care. All your information will be kept private and used solely for the purpose of timely onboarding. The form should take between 10-20 minutes to fill out and autosaves your progress.