To help us understand your individual health concerns, and process paperwork related to health insurance and/or Workers’ Compensation or auto or personal injury claims, we have created a few forms. We will let you know which ones we need you to complete before your appointment.
Here is a brief description of each form:
New Patient Form—Please complete this form if you are a new patient or a returning patient who needs to update personal and/or employer information.
Patient Health Questionnaire—Please complete this form if you are a new patient or are returning to the clinic for help with new health issues.
Back Index Form—Please complete this form if you have Medicare or Blue Cross Blue Shield insurance. The information will help us better understand how your symptoms are affecting your ability to function.
Neck Index Form— Please complete this form if you have Medicare or Blue Cross Blue Shield insurance. The information will help us better understand how your symptoms are affecting your ability to function.
Auto and Personal Injury Checklist—Please complete this checklist if you have, or plan to, file an auto or personal injury claim related to your treatment.
Workers’ Compensation Checklist— Please complete this checklist if you have, or plan to, file a Workers’ Compensation claim related to your treatment.