Patient Paperwork

To better serve you, we have added our patient's medical information and insurance sheets below.  Just click on the links that apply to you, print the form, fill out the paperwork at home and then bring it with you on your initial evaluation. This will speed up the process and allow your therapist more time treating you on your first visit!

PATIENT HEALTH HISTORY
HEALTH HISTORY.docx
Microsoft Word document [206.9 KB]
PAIN CHART
Pain Chart.docx
Microsoft Word document [272.4 KB]
Children (Ages 0-17)
PEDIATRIC_NEW_PATIENT_INFO.docx
Microsoft Word document [14.1 KB]
INSURANCE_INFO.docx
Microsoft Word document [29.1 KB]
CONSENT FOR TREATMENT.docx
Microsoft Word document [173.0 KB]
XRAY_CONSENT.docx
Microsoft Word document [15.7 KB]
HIPPA
This is a mandatory privacy act meant to secure your personal information. All patients MUST have a signed copy in their file before we can perform any treatment.
HIPPA.pdf
Adobe Acrobat document [126.5 KB]
MEDICARE- Advance Beneficiary Notice
This form must be filled out by medicare patients before treatment can be given.
Medicare ABN.docx
Microsoft Word document [22.5 KB]

Personal Injury (Auto Accident, Workers Comp)

Auto Work Related Accident.pdf
Adobe Acrobat document [9.6 MB]
Payment Agreement
LIEN_AUTHORIZATION.docx
Microsoft Word document [180.9 KB]
Payment Agreement
MEDICAL_PROVIDER_CONTRACT.docx
Microsoft Word document [14.2 KB]