Medical History Questionnaire

After you have scheduled your appointment, download, print, and complete the Questionnaire PDF file and bring it with you to my office.

Medical History Questionnaire

Other Forms

The following are pdf forms that you can download, fill out and bring in to me.

Denial of Request for PHI
Fees and Policies
Patient Complaint Form
Receipt of Privacy Notice
Request for Limitation of Use of PHI
Request for PHI
Request to Amend PHI


Dr. Shevin publishes “health alerts” when circumstances warrant.  These include important announcements about his medical practice.  All the alerts are also posted on the Journal page of this website.  To receive these alerts in your mailbox, you will need to give us permission.  A phone call or email to Donna (donna at is all that is needed.