As of May 6, we are no longer accepting new patients.

New Patient Pathway

New Patient Pathway

Welcome to the office of Dr. Donna Pierre.

We look forward to getting to know you and working with you help you become well.

Please download the following forms, print them out and bring them with you to your first appointment, filled out where indicated.

  1. Information Release
  2. Symptoms Checklist
  3. Information Sheet
  4. Requirement for a Primary Care Physician 
  5. Lyme Disease Consent for Treatment
  6. Patient Handbook
  7. Blank Calendar

These forms will help to make your office visit as productive and as pleasant as possible. During your first visit we will spend two hours reviewing your files, discussing your history and examining you. Any blood tests or other procedures will then be ordered as needed. Follow up visits are an hour.

New Patient Pathway Forms

(1) Information Release

Information Release This form will allow you to obtain copies of your medical records from other physicians and hospitals. We are especially interested in hospital summaries, lab, imaging and x-ray reports, consultation letters, and anything else that may prove to be relevant. Please note that once we have them, we are not legally able to release to you or to anyone else, any of your records that did not originally come from this office. Therefore, we suggest that you make copies in advance of any records from other MDs, hospitals, etc., to keep in your own files. Again, it is your responsibility to supply us with appropriate copies, as we will not make photocopies of your original records.  

PDF download

Click the PDF image to download (78kb).  Requires Adobe Acrobat reader. Free Adobe Acrobat Reader Download link
    http://get.adobe.com/reader/otherversions/

(2) Symptoms Checklist

Symptom Checklist- this is an informal survey of the problems that you may have experienced.  
 

PDF download

 
(175kb) PDF file, requires Adobe Acrobat reader). Free Adobe Acrobat Reader Download link
    http://get.adobe.com/reader/otherversions/

(3) Information Sheet

PDF downloadInformation Sheet This provides us with your address, etc., and will save you time if completed ahead of time.
 
(51kb) PDF file, requires Adobe Acrobat reader). Free Adobe Acrobat Reader Download link
    http://get.adobe.com/reader/otherversions/

(4) Requirement for a Primary Care Physician

PDF downloadRequirement for a Primary Care Physician This brief notice is self explanatory- please discuss this with us if you have any questions.
 
(105kb) PDF file, requires Adobe Acrobat reader). Free Adobe Acrobat Reader Download link
    http://get.adobe.com/reader/otherversions/

(5) Lyme disease treatment consent

PDF downloadLyme Disease Consent for Treatment  Please read this, sign it, and bring it with you.
 
(84kb) PDF file, requires Adobe Acrobat reader). Free Adobe Acrobat Reader Download link
    http://get.adobe.com/reader/otherversions/

(6) Patient Handbook

PDF downloadPatient Handbook This Handbook outlines our office policies and procedures. Please read it ahead of time.
 
(126kb) PDF file, requires Adobe Acrobat reader). Free Adobe Acrobat Reader Download link
    http://get.adobe.com/reader/otherversions/

(7) Blank Calendar

PDF downloadBlank Calendar Please use this, if desired, as a daily diary to reflect several weeks prior to the visit. Each day, write down a general statement of how you feel and what in particular you were experiencing.
 
(83kb) PDF file, requires Adobe Acrobat reader). Free Adobe Acrobat Reader Download link
    http://get.adobe.com/reader/otherversions/