All new patients are required to fill out the following two (2) forms
Please complete these forms if you were involved in a Motor Vehicle Accident and your car insurance company will be paying for your appointments.
For hip, knee, leg, foot and ankle
Please complete this form if you are seeking help for pain the lower back area.
Please complete this form if you are seeking help for pain in the neck area, as well as the upper back.
Please complete this form if you are experiencing pain in your jaw.
Direct Billing Online Forms
We are able to bill online for most of our clients, however these two (2) forms must be completed prior to give us your permission.
We have them in the clinic or you may complete online and bring with you to your appointment.
The following forms can be filled out online and can be emailed to prior to your assessment or print and bring along to your appointment.
(Please complete sections 1 & 2 of this form which gives us permission to communicate with your car insurance company)
MVA Patients Only
For hip only
For shoulder, elbow, wrist and hand