New Patient Forms

We have our new patient paperwork available online for download. Completing as much of this paperwork before coming into the clinic for the first time will save you 15-20 minutes of time sitting in the waiting room while filling out the forms. While this is not required for an office visit, it is here for your convenience.

Please use the following links to print and fill out your insurance coverage and patient health history forms. The forms are formatted in Adobe Acrobat, in order to view them you will need Adobe Acrobat Reader installed on your computer. If you do not have Adobe Acrobat Reader you can click here to download it FREE.

“Get Abode Reader”

If you have any questions regarding any of the forms, leave that section blank, bring into the office with you on your first visit and our kind and friendly staff will guide you through any difficulties with the paperwork.

REQUIRED REGISTRATION PAPERWORK FOR ALL NEW PATIENTS

**All new patients to the clinic are REQUIRED to fill out this paperwork. The Notice of Privacy Practices is available for download for your records**
Patient Registration Form.pdf
click to download
Past Medical History.pdf
click to download
Notice of Privacy Practices Short Version.docx
click to download

Low Back Pain Paperwork

If you are experiencing low back pain, please download the following forms, fill them out and bring them with you to your initial visit.

If you are also experiencing neck pain, you only need to download the Bournemouth Questionnaire ONCE.
Bournemouth BackNeck Questionnaire.docx
click to download
FABQ Questionnaire.docx
click to download
Visual_Analogue_Scale.pdf
click to download
Functional Rating Index 1 page.pdf
click to download

Neck Pain Paperwork

If you are experiencing neck pain, please download the following forms, fill them out and bring them with you to your initial visit.

If you are also experiencing low back pain, you only need to download the Bournemouth Questionnaire ONCE.
Visual_Analogue_Scale_1.pdf
click to download
Bournemouth BackNeck Questionnaire_1.docx
click to download
FABQ Questionnaire_1.docx
click to download
Functional Rating Index 1 page_1.pdf
click to download

Headache Paperwork

If you are experiencing a headache, please download the following forms, fill them out and bring them with you to your initial visit.

If this is your "First and/or Worst" sudden headache you have ever experienced, please call 911 or go to the Emergency Room.
Headache Disability Index.pdf
click to download
Visual_Analogue_Scale_2.pdf
click to download