Please only complete this form if you are a new patient to Dr. Cortman & Associates.

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Please note: Email correspondence is not considered to be a confidential medium of communication.

Current Medications:

Include name, dosage, frequency and route.
Click or drag a file to this area to upload.

Over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements:

Click or drag a file to this area to upload.