1. Registration Form - Required for all new patients. Basic demographics and information about your problem.
2. Medical History Form - Required for all new patients. Questions about your medical history, including surgeries or procdure relating to your ailment.
3. Medicare and Priority Health Survey - If you have Medicare or Priority Health insurance that we will be billing please complete a survey for the effected area of the body listed below:
A. Back survey - if your affected area includes your upper, middle, or lower back.
B. Lower body survey - if your effected area includes your legs (knee, hamstrings, quads, IT band, etc), glutes, or groin.
C. Upper body/extremity survey - if your effected area includes your arm, shoulder, wrist, or chest.
D. Neck survey - if your affected area includes your neck.
E. Dizziness survey - if your symptoms include dizziness, vertigo, or a loss of balance.
2. Medical History Form - Required for all new patients. Questions about your medical history, including surgeries or procdure relating to your ailment.
3. Medicare and Priority Health Survey - If you have Medicare or Priority Health insurance that we will be billing please complete a survey for the effected area of the body listed below:
A. Back survey - if your affected area includes your upper, middle, or lower back.
B. Lower body survey - if your effected area includes your legs (knee, hamstrings, quads, IT band, etc), glutes, or groin.
C. Upper body/extremity survey - if your effected area includes your arm, shoulder, wrist, or chest.
D. Neck survey - if your affected area includes your neck.
E. Dizziness survey - if your symptoms include dizziness, vertigo, or a loss of balance.