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(860) 526-9094

Dr. Roger Yates offers our patient form(s) online                  
so you can complete 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) - fax# is (860) 388-5528- or bring it with you to your appointment.


New Client Health History Form - Required  This let's us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with?  We really do read all of your information, so please, let us know!

Download & Print Form

 


 

Worker's Compensation Form - Required  ONLY if condition is the result of a work related injury

This let's us know the history and current state of your health in relation to the work related injury involved.

Download & Print Form

 


Accident/Injury Form - Required ONLY if condition is the result of an auto accident

This let's us know the history and current state of your health in relation to the auto accident involved.

Download & Print Form

 




Download the Free AdobeReader®

 

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