Forms

Prior to your first visit, we ask that you download the New Patient Registration Packet and bring the completed forms with you to your first appointment.

New Patient Registration Packet

Please choose from below the form for the body area that is your chief complaint
Neck Questionnaire
Shoulder and Upper Extremities Questionnaire
Back Questionnaire
Hip_Outcome_Scale
Lower Extremities Questionnaire
Dizziness Questionnaire

HIPAA Privacy Policy

(NOTE: you are not required to print this policy. The Privacy Policy Signature Page is included in the New Patient Registration Packet.)

Additional Miscellaneous Forms

Consent for Treatment of Minor

 

Please be sure to bring the following items with you to your first appointment:

  • The completed forms listed above.
  • Comfortable clothing as noted below:
    • For low back pain or lower extremity problems, please bring shorts and a t-shirt.
    • For females with back, neck, and/or upper extremity problems, please bring shorts and a halter-top, bathing suit top, or one-piece backless bathing suit. Note that a sport back jog bra obscures viewing of the shoulder blades and is not recommended.
  • Your current insurance card.
  • A method of payment (i.e., checkbook, credit card, etc.).