Please print
and fill out all applicable forms and present to
the front desk when you arrive for your office visit.
Call our office if you have any questions.
Patient
Being Seen Today This
form is required upon your initial office
visit with Dr. Meera George Madappallil, M.D.
at MGM Medical Associates, Ltd. SC.
Health
Questionnaire General
health status questionnaire to be filled out
and presented to the front desk when you arrive
for initial office visit.
Preventative
Health Questionnaire (Ages 11 to 24 Years) General health status
questionnaire for persons between the ages
11 to 24 to be filled out and presented to
the front desk when you arrive for initial
office visit.
Preventative
Health Questionnaire (Ages 25 to 64 Years) General health status
questionnaire for persons between the ages
25 to 64 to be filled out and presented to
the front desk when you arrive for initial
office visit.
Preventative
Health Questionnaire (Ages 65+ Years)
General health status questionnaire for persons
age 65 or older to be filled out and presented
to the front desk when you arrive for initial
office visit.
HMO
Eligibility Certification (HMO Patients Only)
Insurance form to be completed by patients
covered by HMO plan. Present this completed
form to front desk when you arrive for initial
office visit.
