Patient forms

If you wish to fill out new patient forms prior to visiting the office, please download and print PDF files here:

1.  Patient Demographics: Patient Demographics

2. Intake Symptoms Form: Intake Symptoms

3. Intake History Form: Intake History

4. Medication list:  Documentation of Current Medications

5. Cancellation Policy:  Cancellation Policy

6. HIPPA Acknowledgement: HIPAA Acknowledgement

*  If your injury was from an accident (Labor & Industries or a Motor Vehicle Accident),           please fill out this accident form: Accident Information

Please select the Functional Index closest to the body part being treated:

 

Notice of Privacy Practices (HIPAA)

***READ ONLY** Do Not Print, Unless you would like for your own records:

Notice of Privacy Practice

 

Please Arrive at least 10 min before your scheduled appointment time and bring with you the above completed paperwork, referral from your doctor and any test results (MRI, X-Ray) you may have.

*** If you are not filling out the paperwork ahead of time, please arrive in our office at least 20 minutes before your scheduled appointment time.***

Thank you! We look forward to meeting you!

Comments are closed.