Patient Forms

Patient Forms

The following forms must be completed by all new patients prior to your first visit.

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• Informed Consent - Electronic HIPAA, consent to treat, and payment policy form required for all new patients.
• Medical History - Electronic medical history information for all new patients.

Please also print and fill out the form that pertains to the area we are treating if listed below:

• Upper Extremities - Arm/Shoulder/Hand
• Lower Back
• Lower Extremities - Hip/Knee/Foot
• Neck
• Dizziness Handicap Inventory
• Falls Efficacy Scale

Medicare Patients - please fill out one additional form

• Medicare Patient Forms