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Patient Health History

Below are the Patient Health History forms for the SBA Medical Group doctors. Please click on the appropriate form below to print, then fill it out and bring it with you to your appointment.

SBA Medical Group – Family Practice with Dr. Jennifer Pharris
Click here for the Health History form.

SBA Medical Group – Allergy/Immunology with Dr. Iram Sirajuddin
Click here for the Health History form.

SBA Medical Group – Orthopedics with Drs. Vikrant Azad and Maxime Coles
Click here for the Established Patient form.
Click here for the New Patient form.

All SBA Medical Group offices
Click here for the Injury form.

720 W. Central El Dorado KS 67042.  (316) 321-3300