Patient Resources

Patient Forms

All new patients are required to fill out the following two (2) forms

The Patient Intake Form

Motor Vehicle Accident Consent Form

Please complete these forms if you were involved in a Motor Vehicle Accident and your car insurance company will be paying for your appointments.

Outcome Measures

Lower Extremity Form

For hip, knee, leg, foot and ankle

Upper Extremity Form

Back Pain Form

Please complete this form if you are seeking help for pain the lower back area.

Neck Pain Form

Please complete this form if you are seeking help for pain in the neck area, as well as the upper back.

TMJ (Jaw) Pain

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.

Benefit Assignment Form

Electronic Transmisson Consent Form

Patient Privacy Policy

Motor Vehicle Accident Disclosure Form

(Please complete sections 1 & 2 of this form which gives us permission to communicate with your car insurance company)

Miscellaneous Forms

MVA Patients Only

Hip Form (iHOT)

For hip only

For shoulder, elbow, wrist and hand