NIS

Online Surgical Consultation

This is required before having a telephone, telemedicine or in office consultation with Dr. Petersen. If you just want to look you are welcome to browse this medical survey.

Please click next below:

What can we help you with?

Hernia

What are your symptoms?

You are:

Male Female

Where? (click the figure, click again if you need to correct)

Male Female

How long have you had this?

  • Days
  • Weeks
  • Months
  • Years
  • Decades

How severe are your symptoms? 10 is worst.

Decrease
  • 0
  •  
  • 2
  •  
  • 4
  •  
  • 6
  •  
  • 8
  •  
  • 10
Increase

What radiology imaging studies have you had?

Review of systems. Do you have?

What exercise do you do?

Do you?

What surgery have you had?

What medical problems do you have?

What medications do you take?

Do you have any medical allergies?

Do you have any questions or additional information for us?

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