Dr. Murphree's New Patient Questionnaire
*PLEASE NOTE: Initial consults are not covered by insurance. Your 45-minute one-on-one consult directly with Dr. Rodger Murphree will be $147. If you have questions / concerns prior to filling out this paperwork for your consult with Dr. Murphree, you may call the clinic at (205) 879-2383, or email us at JunoT2700@gmail.com
First and Last Name *
Your answer
Address *
Your answer
Today's Date
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Home Phone *
Your answer
Cell Phone (or other alternate phone number)
Your answer
Apt #, Unit #, Suite #
Your answer
City, State *
Your answer
Zip Code *
Your answer
Date of Birth *
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Email Address *
Your answer
Height *
Your answer
Weight *
Your answer
What kind of work do you do? *
Your answer
Are you on disability? *
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