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First Appointment

Before you meet the physician for the first time we will ask you to fill out some forms.

The first form is for administration purposes.  We require information like home address, spouses name, employer and insurance details.  This will help us reach you in case of emergency and will also allow us to verify your health benefits in order to avoid unexpected and unpleasant expenses to you.

The second form is a health questionnaire.  You will address allergies, past medical history, family history as well as other important medical issues.  The information given will be a permanent part of your chart and help your doctor make an accurate diagnosis and prescribe a therapy that best fits your need.

The third and final form is called a pain drawing.  This form is especially helpful to the doctor because it provides a visual description of your pain distribution.

Please arrive 30 minutes early on your first visit to our practice.  This will allow time for completion of our paperwork

If you wish, and time allows, we will gladly mail these forms to you at home.

Another option is to download and print these forms right off this web site.

To download these forms, click below then hit print on your browser.  You will need Acrobat Reader to view these forms.  If you do not have it click here to download it for free.

 

Patient Registration

 

 

 

Health History Form

 

 

 

Neck and Back Information Form

 

 

Prescription Medications Form