New Patient Forms

Save time by reading and/or completing these forms at home BEFORE your first visit!  These forms are in the Adobe PDF format - if you have trouble opening them when you click on the name, please try RIGHT clicking on the name and selecting "Open in New Tab" or "Save Link As."   You will be given the option to save the PDF form to your computer.  You can then open it from the folder you saved it to.

Please Read:

  1. Best Results, Least Visits®
  2. HIPAA Notice of Privacy Practices

Please COMPLETE and BRING to your First Appointment:

  1. New Patient Information Form (page 1)
  2. Important Clinic Policies (page 2)
  3. Physical Screening Intake Form
  4. Assignment and UCC Lien
  5. Financial Policy Provisions
  6. Auto Accident Questionnaire (if your injuries are from an auto accident)

Physical Survey Form:

(Complete ONLY those that apply to the condition you are being seen for.)

  1. Low Back
  2. Neck
  3. Upper Extremity (Arm, Shoulder, Hand)
  4. Lower Extremity (Hip, Knee, Ankle, Foot)
  5. Balance
  6. Dizziness
  7. Urinary Incontinence

Click on the NAME of the form, then print to complete by hand.
All files are PDF format.

You will need Adobe Acrobat Reader or some similar program to read these files.  Adobe Acrobat Reader is FREE and often already installed on your computer.
If you are having trouble viewing these files, please consider downloading FOXIT (click here) - another FREE small PDF reader.

 

 

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