New Patient Forms

WELCOME NEW PATIENTS!

Please PRINT OUT these three forms and complete by hand:

1) Confidential New Patient Case History two-page form. Click To Download >>

2) HIPAA (privacy) Form. Click To Download >>

3) Authorization and Assignment Form. Click To Download >>


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.
Click To Download >>

Auto Accident Forms
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.
Click To Download >>


Workers Compensation Forms
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.
Click To Download >>