Online Patient Forms

The FAIRLESS HILLS HEALTH CENTER offers our patient form(s) online so you can complete it in the convenience and comfort 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) or bring it with you to your appointment.

New Patient Case History Form - Required

This let's us know the history and current state of your health. It is required for all new patients, unless you were involved in an automobile accident or a work injury. If that is the case, you would need to fill out one of the forms below.

Download & Print Form


Personal Injury Questionnaire - Required if you were injured in an automobile accident

This let's us know the history and current state of your health. It contains all of the detailed information we will need regarding your specific automobile injury.

Download & Print Form


Work Comp History - Required if you were injured at work

This let's us know the history and current state of your health. It contains all of the detailed information we will need regarding your specific work injury.

Download & Print Form



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Locations

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Office Hours

Our Regular Schedule

Monday

9:00 am - 12:00 pm

4:00 pm - 8:00 pm

Tuesday

Closed am

4:00 pm - 8:00 pm

Wednesday

9:00 am - 12:00 pm

4:00 pm - 8:00 pm

Thursday

Closed am

4:00 pm - 8:00 pm

Friday

9:00 am - 12:00 pm

4:00 pm - 8:00 pm

Saturday

Emergency On Call

Sunday

Emergency On Call

Monday
9:00 am - 12:00 pm 4:00 pm - 8:00 pm
Tuesday
Closed am 4:00 pm - 8:00 pm
Wednesday
9:00 am - 12:00 pm 4:00 pm - 8:00 pm
Thursday
Closed am 4:00 pm - 8:00 pm
Friday
9:00 am - 12:00 pm 4:00 pm - 8:00 pm
Saturday
Emergency On Call
Sunday
Emergency On Call