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We offer our patient form(s) online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) to 806-687-6895 or bring it with you to your first appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with?  These forms are the starting point for our consultation.  Please fill out the appropriate history form, a terms of acceptance, and a profile and bring them with you to the first appointment, email them to ghclubbock@gmail.com or fax them to our office at 806-687-6895 prior to your appointment!

Adult History

Pediatric History

Personality Profile

(If for Pediatric, Parents please fill out personality profile for yourself)

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form



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