For your convenience, forms are provided here for you to complete and bring with you to your appointment. To ensure your online safety and privacy of your records, we ask you to print and complete the necessary forms and fax or hand deliver them to our office. DO NOT EMAIL PRIVATE INFORMATION. Thank you for understanding as we respect your privacy and online safety.
ALL PATIENTS MUST FILL OUT THE TWO FORMS BELOW:
We ask that you bring a valid photo id and any insurance to be filed with you on your first office visit. This is necessary to insure proper billing and identification of our patients.
New Patient Intake
Activity of Daily Living
AUTO INJURY PATIENTS MUST ALSO FILL OUT THESE THREE ADDITIONAL FORMS BELOW:
We ask that you would bring any and all information that you may have in relation to the auto injury for which you will be treated. This includes auto insurance information, claim information, ER notes, Outside doctor notes, Attorney information, Exchange slips or Accident reports.
Auto Injury Intake
Additional Paperwork will be filled out in office.
Please make sure that your employer has been informed of the incident and has a claim number or approval code for your treatment at our office.
Please bring this information with you to your office visit.