Forms

The first visit will be a bit paperwork intensive -- payment information, privacy issues and office policies as well as some patient questions about your pain and health history, but it will quickly lead to your thorough examination with the doctor which will lead to your diagnosis which establishes a baseline for your treatment care plan and outcome expectations.

To help save time on your visit, here are the initial new patient forms for printing at your convenience.

Please bring comfortable clothes like shorts and T-shirt so a proper exam can be performed.


Health Insurance Forms:
New Patient Registration Form (health insurance only)
New Patient Consent & Financial Policies (everyone)
Consent for Treatment (everyone)
Notice of Privacy Practices (everyone)**
Pain Assesment (everyone)

No Show Policy (everyone)

Please select the form that applies to your complaint:
Neck Pain
Back Pain
Upper Extremity Pain
Lower Extremity Pain

Car Accident Forms:
New Patient Registration (Motor Vehicle Accidents only)
Car Accident Description Form
Authorization & Assignment
Lien
Duties Under Duress
New Patient Consent & Financial Policies (everyone)
Consent for Treatment (everyone)
Notice of Privacy Practices (everyone)**
Pain Assesment (everyone)

No Show Policy (everyone)

Worker's Compensation Forms:
New Patient Registration (Work Accident only)
Worker's Compensation Authorization
New Patient Consent & Financial Policies (everyone)
Consent for Treatment (everyone)
Notice of Privacy Practices (everyone)**
Pain Assesment (everyone)

No Show Policy (everyone)

 

**Please read carefully as there are new HIPAA guidelines.