New Patient Center

PLEASE READ:

As a new patient, it is very important for us to gain as much valuable information as we can about you, your complaint and your past health history. This information allows us to give you the quality care you want and deserve. Please, take the time to fill out the forms completely and accurately and bring them with you to your first visit. We have the forms in our office if you choose to complete them there. Please come 15 minutes early if you plan on completing paperwork at the clinic. Thank you.

INSTRUCTIONS:

New Patients:

            1. Fill out New Patient Forms 1- 5

            2. Fill out Outcome Assessment Form that corresponds with the area of injury/pain (up to three (3)).

*Auto Patients Only:

            1. Fill out Auto Accident 1-6

            2. Fill out Outcome Assessment Form that corresponds with the area of injury/pain (up to three (3)).

New Patient Forms:

1. New Patient Intake Form
2. Present Complaint Questionnaire
3. Past Health History Questionnaire
4. Informed Consent
5. Financial Policies

Auto Accident Only:

1. New Patient Intake Form
2. Auto Accident Questionnaire
3. Lien Form (Only if case is on a lien basis)
4. Past Health History Questionnaire
5. Informed Consent
6. Financial Policies

Outcome Assessment Forms:

1. Low Back Pain Disability Questionnaire
2. Neck Pain Disability Questionnaire
3. Hand, Elbow, Shoulder Pain Questionnaire
4. Ankle, Knee, Hip Pain Questionnaire
5. Headache Disability Questionnaire
6. Dizziness Disability Questionnaire
7. General Pain Level