New Patient Questionnaire

If you are a new patient (or haven't been seen in a while), we need to collect the following information before you can be seen. To save time at your appointment and avoid delays, please fill out and submit this form beforehand. This should take about 5 minutes to complete.

You may either fill out the form electronically and email it to us, or print this form and bring it to your appointment.

Pre-operative Instructions

Glen Carbon

4802 S. State Route 159
Glen Carbon, IL 62034
(618) 288-4388

Granite City

2044 Madison Avenue, Suite G5
Granite City, IL 62040
(618) 288-4388

Sparta

1300 N. Market Street
Sparta, IL 62286
(618) 443-4138

David Zhu, MD

Orthopedic Surgery | Sports Medicine Specialist