Neuropathy Application For Admission
Welcome to DuPage Healthcare!

We are pleased you have chosen us to be your partner in healthcare and are confident that you have made the right decision.

DuPage Healthcare has focused on health and healing in our community for nearly 23 years. As we innovate and grow, we keep one thing at the forefront of all we do, and that is what is best for our patient –
what is best for you.

One thing we know is essential in being partners in your health is communication. This paperwork was developed to help Dr. Pepping to understand your condition and especially how it may be affecting your quality of life. We ask that you answer it as thoroughly and honestly as possible.

• Our office requires your paperwork to be completed prior to your appointment.
• If possible, submit your completed paperwork no later than a day before your appointment.


YOUR APPOINTMENT DAY-
Because Dr. Pepping always runs on time, we ask that you do the same.

We take our work very seriously and are honored that you trust us with your care.

Sincerely,

Crystal
Case Coordinator/Office Lead
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