Patient Forms

Below are some of our forms for your visit.  You can either click on the link (which will open it in your browser) or right-click and save-as (which will give you the option to save it to your computer).

For privacy reasons, please fill out the form and bring it with you to your appointment.  Do not email your completed form to us.


New Patient Forms:

New Patient Questionnaire

(If you are a new patient being seen for headaches or migraines, please do not use this form. Use the form at the bottom of this page instead.)


Notice of Privacy Policy (HIPAA):

HIPAA Notice of Privacy Policy

This document is to be used for your review.  After you have reviewed it, please sign the bottom of the first page of the new patient form acknowledging that you have reviewed it.


Headache & Migraine New Patient Form:

Please use this ONLY if you are coming to see Dr Whitaker for headaches and/or migraines.  Please note that on the last 2 pages is a list of medications for your reference in filling out the current and past headache medications found on pages 3 & 4.

New Patient Questionnaire for Headaches & Migraines