Online Forms

We offer our paperwork on line so you can complete it in the convenience of your own home.


Adult Health History

This let’s us know what’s happened, but perhaps more important, where do you want to take your health?

 Download & Print Form


Children Health History

Please Download & Print the forms that are age appropriate for your child and bring them with you to your appointment.

Your Child is from Birth - 2 Months


 Your Child is from 2 Months - 2 Years


 Your Child is from 3 Years to 5 Years


 Your Child is 6 years +


Automobile Accident

If your health issue is the result of a car accident, we need some additional information.

 Download & Print Form


Free AdobeReader®

Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.




Dr. Jamie Lenz | (608) 274-6200
1001 South Whitney Way, Madison, WI

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