Paperwork | Med Recs

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Dr. Kris Armstrong
Smoklahoma
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Paperwork

Use tab to navigate through the menu items.

New Patient Paperwork

First & Last Name

Email

Phone

Address

Is this a ...

Do you have

Medicare or Medicaid

Soonercare

Does not apply

Do you take any medications?

No

Yes

Are you a Veteran?

No

Yes

Medical History - Select all that apply

Glaucoma

Parkinson's Disease

Huntington's Disease

Multiple Sclerosis

ALS

HIV/AIDS

Chrohn's Disease

Ulcerative Colitis

IBS

Ulcers

Cancer

Asthma

Diabetes

Neuropathy

Kidney Disease

Psoriasis

Psoriatic Arthritis

Seizers

COPD

Congestive Heart Failure

Stroke

Medical History Continued

Osteoarthritis

Lupus

Paralysis

PTSD

Anxiety

Depression

Insomnia

Headaches

Migraines

Nausea

Poor Apetite

Chronic Pain

Chronic Back Pain

Chronic Neck Pain

Sciatica

Numbness or Tingling

Hyperlipidemia

Hypothyroidism

Skin Issues

Obesity

Other Condition

Important Family Medical History

Other Conditions or surgeries NOT listed

State Form ID (FRONT)

Upload File

Upload supported file (Max 15MB)

State Form ID (BACK)

Upload File

Upload supported file (Max 15MB)

Digital Signature

How did you find us?

Date of Birth

*IF PEDIATRIC* Birth Certificate

Upload File

Upload supported file (Max 15MB)

If GUIDED do you give us permission to pass along your paperwork to your portal guide?

Yes

No, I am uploading myself

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