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We request all new patients complete The New Patient Questionnaire. 

Please click Next at the bottom of the page to complete the online form.


If you have difficulty with this online form, 

You may instead download the PDF version here

When the pdf form is complete, please email to 

BSI Home Page  

Important Instructions

Recommended protocols to ensure the New Patient Survey is properly received, and to save you time: 

1) You may need to disable ad blockers on for proper function. No ads or tracking are contained in the New Patient Questionnaire.

2) If you need to leave the survey for more than 25 minutes, be sure to click “Resume Later” so that your responses will not be lost. This is a necessary security function. Your personal data must be protected.

3) If the session has expired, log in again using the address and password you were sent via email.

4) For your benefit, please fully answer all questions, as the basis of your analysis is a detailed medical history.

There are 67 questions in this survey.