New Patient Forms

WELCOME NEW PATIENTS!

Please fill out these three required forms (links are to the right in the white sidebar):

1) Confidential New Patient Case History two-page form

2) HIPAA (privacy) form

3) Authorization and Assignment form

Under 18 years? If we will be treating a MINOR (under 18), please print the “Consent to Treat a Minor” form in addition to the three New Patient forms above. We will need a parent or guardian signature before we can treat a minor.

NOTE: If you have had a Motor Vehicle Accident or Workman’s Comp accident—PLEASE INFORM US AT TIME OF SCHEDULING so that we can schedule the appropriate amount of time for your care and we will discuss what else is required from Insurance companies in regards to these claims.

Motor Vehicle Accident? If you have been involved in a Motor Vehicle Accident and are seeking treatment related to that claim, please print and fill out the Auto Accident questionnaire in addition to the Required forms above if you are a new patient. If you are an established patient...just the accident form.

Workman’s Comp Claim? If you have been involved in a Workman’s Compensation Claim please print and fill out the “Workman’s Compensation Form” along with the Required forms above if you are a new patient. If you are an established patient...just the Work Comp form.

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