Download to Complete

General Forms

Please select the forms package that best describes your insurance reimbursement situation.  After completing the general forms, please select the "Problem Based Form" that best applies to your condition.  All forms are in PDF format.  If you do not have Adobe Reader, please click on the icon below. 

 

      New Patient's - Please Complete the following Paperwork 

Problem Based Forms for New and Returning Patients.

Please select the appropriate forms that match with your condition:

Headaches and/or dizziness: Headache & Dizziness Index

Neck and/or Back pain: Functional Rating Index

Arm, Elbow, Shoulder, Wrist/Hand pain: Disability, Arm, Shoulder and Hand

Hip, Knee, Ankle pain: Lower Extremity Functional Scale

 

Release of Medical Records

If you have recently received treatment at another facility, please complete the Medical Records Release Form so that we may obtain a copy of those records.


Estabilished/Returning Patients Please Complete: 

 

The Following List of Problem Based Forms are for United HealthCare Patients ONLY:

Please select the appropriate forms that match with your condition:

Low back pain: Back Index

Neck Pain: Neck Index

Arm, Elbow, Shoulder, Wrist/Hand pain: Disability, Arm, Shoulder and Hand

Hip, Knee, Ankle pain: Lower Extremity Functional Scale