Have you seen this physician before?
Yes No
Are you experiencing a fever, cough or difficulty breathing OR have you been tested for coronavirus (COVID-19) in the past 14 days?
Yes No
Have you ever seen a physician for this problem before?
Yes No
Please contact Thomas Hart Family Practice Center at (717) 851-2521 to discuss the EDS clinic.
Have you been advised by your primary care physician to see a surgeon?
Yes No
Have you been advised by your primary care physician to see a neurosurgeon?
Yes No
Have you been advised by your primary care physician to see a neurologist?
Yes No
Is this related to a workers' compensation or automobile accident claim?
Yes No
Are you currently on pain medication or are you looking for a physician to help manage your pain medication?
Yes No
Are you scheduling a prenatal massage (currently pregnant) or is this related to a workers' compensation or automobile accident claim?
Yes No
Is the patient under 19 years old?
Yes No
Please contact us at to schedule a visit.
Pediatric medicine practices treat children from newborns to age 18. Pediatric medicine services include newborn visits, well-baby and well-child care, sick/injury care, immunizations and physicals.
Is the patient 18 years or older?
Yes No
Did you have a GI procedure within the past week and are actively having uncontrolled rectal bleeding, severe abdominal pain, fever 100.5 or greater or uncontrolled vomiting?
Yes No
Do you have trouble swallowing or feel like there is something caught in your throat? Inability to swallow saliva/liquids?
Yes No
Are you having an allergic reaction to your medication?
Signs include: difficulty breathing, tongue or lip swelling, chest pain, vomiting.
Yes No
Are you 18 years of age or older?
Yes No
Have you been diagnosed or referred by a healthcare professional for this disease?
Yes No
We do not currently see anyone under the age of 18. Please contact your PCP or referring provider to discuss your options.
Please contact your PCP or referring provider to discuss your concerns.
Is the patient under the age of 18?
Yes No
Have you been advised by your primary care physician to schedule your child with a pediatric neurologist?
Yes No
Please contact your primary care physician to discuss a referral.
Are you scheduling for a concussion, pain management, ADHD, Autism, behavioral issues or sleep disorders?
Yes No
Before we continue
Are you sure you should wait to get care?
If you think might be having a heart attack, even if you're not sure, call 911 immediately. Fast treatment could save your life.
Some symptoms of a heart attack include chest pain, shortness of breath, changes in heart rhythm, dizziness or trouble with balance.
Continue to Cardiology Scheduling
Have you been advised by your primary care physician to see a cardiologist?
Yes No
Have you been advised by your primary care physician, cardiologist or another specialist to schedule an appointment?
Yes No
Are you experiencing any of the following:
- Feeling like you are going to pass out or faint
- Unable to catch your breath
- Swelling
- Chest pain or discomfort
- Changes in heartbeat, racing heart or fluttering in chest
- Dizzy or lightheaded
- Changes in balance/unsteady
- Inability to move arms/legs
- Cold/Pale extremities
Yes No
Has your primary care provider or another physician recommended that you see a vascular surgeon?
Yes No
Are you experiencing any of the following:
- Feeling like you are going to pass out or faint
- Unable to catch your breath
- Swelling
- Chest pain or discomfort
- Changes in heartbeat, racing heart or fluttering in chest
- Dizzy or lightheaded
- Changes in balance/unsteady
Yes No
Has your primary care provider or another physician recommend that you see a cardiovascular surgeon?
Yes No
Are you experiencing any of the following:
- Feeling like you are going to pass out or faint
- Unable to catch your breath
- Swelling
- Chest pain or discomfort
- Changes in heartbeat, racing heart or fluttering in chest
- Dizzy or lightheaded
- Changes in balance/unsteady
Yes No
Has your primary care provider or another physician recommend that you see a thoracic surgeon?
Yes No
Would you like to make an appointment for a vasectomy consultation and have Capital Blue Cross, United Healthcare or United Healthcare Community Plan Insurance?
Yes No
Are you scheduling an appointment for STD, HIV, Vaginal Infection, Hepatitis C, Scabies or Lice?
Yes No
We're sorry. These conditions are not treated by this practice. Please contact your primary care physician for a referral.
Are you scheduling an appointment for Hepatitis?
Yes No
Are you 18 years of age or older?
Yes No
We're sorry. This practice only treats adult patients. Please contact your primary care physician for a referral.
Are you 21 years of age or younger?
Yes No
Have you ever had a baby?
Yes No
Is the patient over 18 years of age?
Yes No
Internal Medicine providers treat patients over the age of 18.
Is the patient over 18 years of age?
Yes No
Have you been advised by your primary care physician to see a rheumatologist?
Yes No
Please contact your child's provider to schedule an appointment.
You are about to schedule an evaluation, not a procedure. Would you like to schedule a procedure?
Yes No
Do you have a personal history of melanoma or an area of immediate concern?
Yes No
Has your provider advised you to schedule MOHS surgery?
Yes No
Do you have an ear infection, sudden hearing loss, gradual hearing loss or dizziness?
Yes No
Do you have any Audiology needs (hearing aid issues, inquiring about hearing aids)?
Yes No
Is your issue related to an orthopedic injury such as low back pain, cervical pain, joint pain, joint injury, muscle injury, sprain or strain?
Yes No
Please select yes if any of the following apply to you:
- You been recently discharged from the hospital
- This related to a worker’s compensation claim
- You have had surgery within the past three months
- This a new injury within the past two weeks
- You have an order for more than one therapist
Yes No
Have you been advised by your care team to have a physical therapy evaluation?
*If you have a paper order, please bring it with you on the day of your appointment.
Yes No
Have you been advised by your primary care or OB/GYN provider to see a Urogynecologist?
Yes
No
Are you scheduling an appointment for a cosmetic consultant?
Yes
No
Have you been referred to nephrology by your primary care physician?
Yes
No
Are you scheduling an appointment for hypertension?
Yes
No
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