**AVAILABLE FOR TELEMEDICINE** Wesley Chapel & Tampa Offices Open This Morning ONLY - All Offices Will Be Closed Wednesday Due To Hurricane Milton
BayAreaEndoAssociates@Gmail.com
Serving All Of Tampa Bay

Personal History & Evaluation of Patient Health Form

Patient Home Glucose Monitoring Log

    Patient Information:
    Name:
    Date of Birth:
    Gender:
    Contact Number:
    Email:

    Reason for Visit:

    Past Medical History:
    Select any common diseases you have had:
    DiabetesHypertensionHeart DiseaseAsthmaCancerArthritisThyroid DisordersStrokeChronic Kidney DiseaseCOPDOsteoporosisAnemiaHepatitisMental Health DisordersAutoimmune DiseasesOther

    Marital Status:

    Personal Habits:
    Smoking: YesNo
    Drinking: YesNo
    Other Substances Used:

    Past Operations:
    1.
    2.
    3.

    Serious Injuries:
    1.
    2.
    3.

    Hospitalizations:
    1.
    2.
    3.

    Urgent Care/ER Visits:
    1.
    2.
    3.

    Radiation Treatments:
    1.
    2.
    3.

    Family History:
    (Fill in "Health," "Age," and check if "Deceased")
    Father: Yes
    Mother: Yes
    Sister(s): Yes
    Brother(s): Yes
    Wife/Husband: Yes
    Daughter(s)/Son(s): Yes

    Body System Review:
    Have you experienced any of the following symptoms in the last 3 months constantly, more than 2-3 times a week?
    Skin: RashesItchingDrynessOther
    Eyes: Blurred VisionRednessDrynessOther
    Nose and Throat: CongestionSore ThroatNosebleedsOther
    Breasts: LumpsPainNipple DischargeOther
    Musculoskeletal: Joint PainMuscle WeaknessBack PainOther
    Digestive: NauseaVomitingDiarrheaOther
    Genitourinary: Frequent UrinationPainful UrinationBlood in UrineOther
    Endocrine: Excessive ThirstExcessive HungerWeight FluctuationsOther
    Neurologic: HeadachesDizzinessNumbnessOther
    General: FatigueFeverWeight LossOther
    Heart and Lung: Chest PainShortness of BreathCoughOther

    Past Medications and Dosage:
    1.
    2.
    3.

    Medical Allergies:
    1.
    2.
    3.

    Other Comments:

    Opening Hours

    Meet Our Endocrinologists

    Our Endocrinologists, Dr. Carlo A. Fumero, Sean Amirzadeh, DO, Alberto Garcia Mendez, Lauren Sosdorf, and Pedro Troya, are board certified by the American Board of Internal Medicine and have a wealth of experience treating thyroid conditions. They will work with you to create a personalized treatment plan that meets your unique needs.

    OUR TESTIMONIALS

    What our patients say about us

    Deborah Diaz
    Deborah Diaz
    Attentive, thorough, compassionate, genuine, loyal.
    Read More
    As a patient of Dr. Troya’s for several years, I would highly recommend this endocrinologist to anyone. He gives full attention to you and your needs without being pressed for time. His diagnosis and treatments are thorough with up-to-date technology and years of experience. His concern and compassion are genuine with your best interest at heart. After having multiple biopsies performed by Dr. Troya, I am definitely a loyal follower.
    Victor Cruz
    Victor Cruz
    Successful diabetes treatment, complete care
    Read More
    I have been going to Dr. Troya for a year. He has treated my Diabetes with great success. He communicates with my other doctors, so he has a complete medical history of all my health issues. We need more caring doctors like Dr. Troya who has the patient’s best interest at heart. I am very thankful for Dr. Pedro Troya.
    Michael Hoover
    Michael Hoover
    Stabilized diabetes, regained pilot's license.
    Read More
    I was a private pilot for 34 years before contracting Type 1 diabetes after a severe case of food poisoning in March of 2008. My first endocrinologist refused to assist me in working with the FAA to retain my pilot’s license. I became a patient of Dr. Troya in 2010. Since that time, he has put me on a Continuous Glucose Monitoring regime and helped me stabilize my blood glucose levels to levels that allow me to pass my FAA medical exam. His caring and interest in each patient's personal issues, as well as their medical outcomes, marks him as an outstanding physician.
    KC Mullis
    KC Mullis
    Personable, caring, thorough, trusted physician.
    Read More
    Dr. Carlos Fumero is a very personable and caring physician. He takes the time to listen and is very thorough in his evaluations and explanations. He exercises incredible care and concern. I have been referring family members and friends to Dr. Carlos Fumero for almost two years now. We are all exceptionally grateful to have found such a trusted physician. Thank you, Dr. Carlos Fumero. Your kindness and medical expertise are more appreciated than I could ever express in words.
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