Printable Forms

Please Read:
As a new patient, it is very important for us to gain as much valuable information as we can about you, your complaint and your past health history. This information allows us to give you the quality care you want and deserve. Please, take the time to fill out the forms completely and accurately and bring them with you to your first visit. We have the forms in our office if you choose to complete them there. Please come 15 minutes early if you plan on completing paperwork at the clinic. Thank you.

INSTRUCTIONS:

New Patients: First, fill out New Patient Forms 1- 4. Second, fill out an Outcome Assessment Form that corresponds with your top two complaints.

Existing Patients: Please download your Rehabilitation Forms to refresh your memory of your rehab plan or support instructions.

NEW PATIENT FORMS:

1. New Patient Intake Form
2. Present Complaint Questionnaire
3. Past Health History Questionnaire
4. Informed Consent

OUTCOME ASSESSMENT FORMS:

1. Low Back Pain Disability Questionnaire
2. Neck Pain Disability Questionnaire
3. Headache Disability Questionnaire
4. Dizziness Disability Questionnaire

REHABILITATION FORMS:

1. Core Program: Phase 1,2,3
2. Shoulder Program: Phase 1,2,3
3. Upper Cross/Neck Program: Phase 1,2,3
4. Ankle/Shin Program: Phase 1,2,3
5. Knee Program: Phase 1,2,3