New Patient forms– Please print out and complete the forms below.   Bring the completed forms as well as your insurance cards, and medication list.  We ask that you arrive 15 minutes early to review these forms and your insurance coverage.

ALL NEW PATIENTS FILL OUT:

In addition you will also fill out ONE of the following:

  • If you are being treated for NECK / UPPER BACK PAIN please complete: Neck Index
  • If you are being treated for LOW BACK PAIN please complete: Back Index
  • If you are being treated for UPPER EXTREMITY / ARM PAIN please complete: DASH  unless you have Medicare or a Medicare Replacement Plan then fill out UEFI
  • If you are being treated for LOWER EXTREMITY / LEG PAIN please complete: LEFS unless you have Medicare or a Medicare Replacement Plan then fill out WOMAC
  • If you are being treated for VERTIGO / DIZZINESS please complete: Dizziness Handicap Inventory