Important: Please read before filling out this form:
If you have spoken to Dr. Yerby, and been accepted as a new patient, you may proceed with the next step by filling out this health history form.
Please do not fill this out unless you have first been in either email or phone contact with Dr. Yerby. This form is for active new patients, only.
Hit the SUBMIT button only once at the end of the form. The form will be returned by email over a secure server. It is recommended that you print a copy for yourself, as well.
Please be back in touch with Dr. Yerby by phone or email within 24 hours to set up your appointment if this has not already been done. 919-704-6298