Past Medical History Information

Submitted by admin on Fri, 08/12/2011 - 11:20am
:
Please list your past surgeries/hospitalizations with dates of each:
If you selected 'Yes' to Respiratory Illness, please specify the type here. (Asthma, COPD, etc.)
If you selected 'Yes' for Cancer, please specify the type of cancer.
Please least any other past or current medical conditions not listed above.
Is there a family history of the illness/condition we are seeing you for today? If so, please specify relationship of family member.
Please list your drug allergies:
Please specify all current medications you are currently taking. Leave blank if none.
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Contact Info

598 N. Union Ave Suite 230
New Braunfels, TX 78130

Phone: 830-627-3777
Fax: 830-627-3778
After Hours: 830-632-2070

© 2008-2011 ENT Center New Braunfels. All Rights Reserved.

Hospital Affiliations

Guadalupe Regional Medical Center

Seguin

Christus Santa Rosa Outpatient Center

New Braunfels

Christus Santa Rosa

New Braunfels

Central Texas Medical Center

San Marcos
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