Health History Form

Thank you for entrusting your care to us at the Marino Center. We encourage you and your family members to ask questions and tell us how we can enhance your experience.

You may be asked to arrange for certain items, such as medical records, to be sent as soon as possible, and to hand-carry other materials to your appointment, including our New Patient Packet which is avialble below. When you arrive for your first appointment you will be asked to provide us with a photo ID and health insurance card (s). You will also be asked to sign appropriate consents and acknowledgement forms, so it is important to arrive 15 to 20 minutes early.

Your health insurance provider may require you to get a referal or out-of-network approval for services at the Marino Center. Please contact your primary care physcian or insurance provider to find out if they are needed before your visit.

Preventative care is an important part of your health care. The following packet asks questions about your medical history as well and your current lifestyle and will assit you and your physician to your health care plan. Please fill out this packet and bring it with you to your first visit.

Download New Patient Packet