Sierra Rheumatology
New patient intake

New Patient Intake

Tell us about you, your symptoms, and your medical history before your first visit.

About this form

Please complete this intake form before your first appointment. The more we know in advance, the more focused we can keep your visit. All information you submit is encrypted in transit and only seen by our clinical team.

About 12 minutes
Progress
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Patient information
Present illness

Please describe what brings you in today.

Rheumatologic history

Have you ever been diagnosed with any of the following?

Select all that apply
Family history

Has any blood relative ever been diagnosed with the following?

Select all that apply
Medications & allergies
Sign & submit

Submitting transmits this form securely to our office. For urgent medical issues please call our office or 911.

Trouble with the form?

Call our office and we'll either walk you through it or send a paper version.

Call (916) 677-4744← All forms