Patient Forms

Your time is valuable! We are providing paperwork here for you online to bring to your first appointment. Please fill out these documents and bring them with you when you come in for your first appointment. Occasionally, different insurance companies require additional information that you may need to complete upon check-in, but filling out these forms will help alleviate at least some of the required paperwork.

My insurance carrier is Medicare

• Medicare Patient Forms

My insurance carrier is not Medicare

• Non-Medicare Patient Forms

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United Healthcare Patients

United Healthcare requires different patient forms. If your insurance is through United Healthcare, these are the forms you need to fill out. Please print the forms, fill the forms out completely and bring them to your first office visit.

You will need to fill out two separate forms.

1. All patients with United Healthcare insurance must fill out the Patient Health Questionnaire.

   -	Patient Health Questionnaire (download this form)

2. You will also need to fill out a form based on your particular injury - back, neck, lower extremity, or arm/shoulder/hand. In addition to the Patient Health Questionnaire, please only fill out the form that applies to your particular injury.

   -	Back Injury (download this form)
   -	Neck Injury (download this form)
   -	Lower Extremity Injury (download this form)
   -	Arm Shoulder Hand Injury (download this form)