| Please use one of the following methods to provide your information. |
|---|
| 1. Call 1-877-339-5274 and become a new patient |
| 2. Use our online personal health record system. |
| 3. Transfer data from another Personal Health Record to our office. |
| 4. Request a history & physical report from another doctor's office. |
| 5. Request data from your health or life insurance company. |
| 6. Request a discharge summary from your hospital. |
| 7. Purchase health or life insurance online. |
| 8. Transfer data from your Regional Health Information Exchange |
| 9. Transfer data from your pharmacies and/or prescription benefit manager. |