Forms

PLEASE DO NOT PRINT THE NEW PATIENT FORMS. FILL OUT ONLINE AND CLICK SUBMIT AT THE END.  – THANK YOU

New Patient Forms– Please complete, with as much detail as possible and click submit at the bottom of the forms when finished. Please do not print these electronic forms.Your secure information will be sent directly to us. IF YOU DO NOT WISH TO FILL OUT ELECTRONIC FORMS, PLEASE ARRIVE 30 MINUTES BEFORE YOUR SCHEDULED APPOINTMENT TIME TO FILL OUT PAPER FORMS AT OUR OFFICE. 

Minor Consent Form– Please print, sign and bring to your first appointment for patients under 18 years of age.

Other Forms

Notice of Privacy PracticesKeep for your records.

Accident Report Form – Please complete, for Automobile, Personal Injury or Workers Compensation Claims. Please complete with as much detail as possible, electronically sign and click submit when finished. Please do not print these electronic forms.Your secure information will be sent directly to us.  

Medical Records ReleasePlease print, complete and return if you need to request a copy of your records.

Authorization to speak to family members/friends – Please print, complete and return if you would like us to speak to anyone about your care, appointments and billing on your behalf.

Optum Health Patient SummaryPlease print, complete bottom section and bring to your appointment if you have Optum Health, UHC or Great West and your insurance requires Optum Health Approval.

Functional Outcome Assessments 

Low Back Roland Morris

Neck Disability Index

Headache Disability

Upper Extremity Functional Scale

Lower Extremity Function Scale