Family Physicians of O'Fallon
New Patient Appointments

If you would like to become a patient at Family Physicians of O'Fallon, first check to make sure that we accept your insurance. Once you have determined that you insurance is accepted, please download our Past Medical History Questionnaire. When you have printed out the form and completed it, please drop it off at the office. Once we have received your questionnaire, we will call you to schedule your New Patient Appointment.

For children, please use the Pediatric History Questionnaire

You will also need to download our Intake Form. Please have this filled out before your first appointment and bring it with you -- it will speed things up tremendously!

Adult Past Medical History Questionnaire

The questionnaire is available in either Microsoft Word (.doc) or Adobe Acrobat (.pdf) format:

Pediatric Past Medical History Questionnaire

The questionnaire is available in either Microsoft Word (.doc) or Adobe Acrobat (.pdf) format:

Intake Form

Please read our Medication Refill Policy.