Microsoft word - new patient clinical information form, final, 14mar03.doc
William R. Klemme, M.D. Diplomat, American Board of Orthopaedic Surgery Practice Limited to Spine Surgery Adult and Pediatric Spine Surgery Degenerative and Deformity Conditions NEW PATIENT CLINICAL INFORMATION FORM Is your problem related to: Job injury Briefly describe your main problem/complaint. Also, describe the injury that caused these symptoms, if applicable. How