1820 Haynes Street

Clarksville, TN 37043

Looking to learn more about your options? Be in touch and see how we can help.

P: (931) 245-1500

F: (931) 245-1544

Prepare in Advance

WEIGHTLOSS QUESTIONNAIRE

New weightloss patients will need to fill out the weightloss questionnaire, consisting of Demographics, Personal and Family History, Medication Lists, Surgeries, etc. This paperwork assists our providers in creating the best possible care plan. To help speed up the process, Dynamic Healing, LLC is including the packet below so you have to option to fill it out in advance. If you choose to fill out your packet in advance, you can either 1.) print it off and bring it with you, or 2.) save it and send it as an attachment to medrec@dynamichealingllc.com. We do still ask that you arrive 5-10 minutes prior so we have time to make copies of your identification card and obtain any missing information. Thank you. We look forward to serving you!