New Patient History Questionnaire Information at AAA Urgent Care in Tamarac, FL.

Thank you for choosing AAA Urgent Care as your healthcare partner.

Current step:Step 1
Step 2

PAST MEDICAL HISTORY

Have you ever been diagnosed with any of the following ?

1: Have you ever had a positive TB (tuberculosis), PPD or TINES test?.
2: Have you ever had a blood transfusion?
3: Have you ever been admitted to the hospital?

New Patient History Questionnaire

Females Only

Have you ever had an abnormal Pap or Mammogram?

Family History

Any family member(mom, dad, brothers, sisters, grandparents)with any of the following
Sudden Death (before 45 years old?) Yes No
Do you Smoke:
Drink alcohol:
Street Drugs: