Forms for Our Patients
Our goal is to serve our patients in the manner they are the most comfortable. We’ve had several requests from our patients to make our forms available online. We are in the process of making these documents available to be filled out and submitted online. That is still a work in progress, but for now we have made them available to download. To save time, you may print and complete our patient documentation before your visit. We have broken down our forms to fit the three types of patients that come to see us.
New Patient Documentation
Most new patients fall into this category. The only exceptions to this are the involvement of either a personal injury caused by an automobile accident or worker’s compensation case. In those instances, please refer to the next sections. Otherwise, please click here to download and fill out the general new patient forms. This set of documentation will contain the following documents to fill out:
- New Patient Introduction
- Confidential Patient Information
- Family History
- Privacy Notice (signature page)
Please be sure to fill out each page in its entirety. For the full privacy policy, please see the bottom of this page.
If you have any question, please don’t hesitate to call our office or bring the forms in with you on your first visit. We’re more than happy to review the forms with you and answer any questions that you might have.
New Patients with a Automobile Involved Personal Injury
These forms are specifically for new patients that have experienced a personal injury involving an auto accident. Please click here to download and fill out the general new patient forms. This set of documentation will contain the following forms to fill out:
- New Patient Introduction
- Auto Accident History
- Family History
- Privacy Notice (signature page)
- Medpay Signature Page
- Authorization and Assignment Page
Please be sure to fill out each page in its entirety. For the full privacy policy, please see the bottom of this page.
This set of documentation tends to be more involved, and you will likely have a question or two about certain areas. If you have any question, please don’t hesitate to call our office or bring the forms in with you on your initial visit. We are more than happy to review the forms with you and answer any questions that you might have.
New Patients with a Worker’s Compensation Related Injury
These forms are specifically for new patients that have experienced an injury involving Worker’s Compensation. Please click here to download and fill out the Worker’s Compensation documentation. The file contains the following items to fill out:
- New Patient Introduction
- Worker’s Compensation History
- Family History
- Privacy Notice (signature page)
Please be sure to fill out each page in its entirety. For the full privacy policy, please see the bottom of this page.
This set of documentation tends to be more detailed, and you will likely have a question or two about certain areas. If you have any question, please don’t hesitate to call our office or bring the forms in with you on your initial visit. We are more than happy to review the forms with you and answer any questions that you might have.
Other Documentation
The following items may need to be filled out under certain circumstances, or if you are a returning/existing patient:
- Change of Condition
This is for current, existing patients only. The purpose of this document it to identify a condition that is being treated becoming worse. The questions are intended to identify the root cause so our team can effectively provide the best experience for you. - Consent to Treat a Minor
If the patient to be seen is less than 18 years of age, please be sure to have a legal guardian complete and sign this document.
Privacy Notice
While the above links contain just the signature page, this document is the full version of our Privacy Notice.