Questionnaires & Intake Forms

All new patients must pre-fill a questionnaire or intake form out before their initial visit with Dr. Tanya Escobedo.

From ChARM Patient Portal, you can fill pre-appointment questionnaires shared by Dr. Tanya Escobedo prior to your office visit. Once your appointment is booked an email will be sent to you with a link to her intake questionnaire.

questionairesThis significantly reduces the time you spent in waiting room, during appointment, and helps Dr. Escobedo to know about you in advance.
You will receive an email notification when Dr. Escobedo shares the questionnaire with you. In addition, a notification icon (with count) is shown on top right corner of  ‘Questionnaires’ section if you have any questionnaires to fill.

 

To fill pre-appointment questionnaire

    1. Login to Patient Portal: CharmEHR
    2. Patient Portal
    3. Go to the ‘Questionnaires’ section
    4. Choose a questionnaire, fill the details and click on Save

The ‘Current’ tab lists the questionnaires to be filled for your upcoming appointment. Fill
all the questionnaires listed under the ‘Current’ tab.

Paper Intake Forms

If you are having difficulties getting into the portal, or you prefer old fashion paper you can print and fill out the paper version here.
Female Intake Form

Male Intake Form