Patient Forms
Welcome to our paperless office!
Our office strives daily to operate as greenly as possible. Here are just a few reasons why we have minimized our paper use.
- 42% of the industrial wood harvest is used to make paper.
- Paper accounts for 25% of landfill waste (and one third of municipal landfill waste).
- 28% of paper produced is copy or print paper, which is reponsibe for 20 million metric tons of carbon dioxide released into the atmosphere
- If the United States cut office paper use by just 10% it would prevent the emission of 1.6 million tons of greenhouse gases -- the equivalent of taking 280,000 cars off the road.
- The pulp and paper industry is the third largest contributor to global emmisions, which does not include the emissions from the logging process or shipping of the final product.
- We use recycled paper. According to RecycleWorks.org, “20 cases of 100% recycled paper saves 17 trees, 390 gallons of oil, 7,000 gallons of water and 4,100 kwh of energy … [and] also eliminates 60 pounds of air-polluting emissions and saves eight cubic feet of landfill space.”
Prior to your New patient or Re-evaluation visit, please complete the appropriate forms located below.
Please be advised that we will need all of your intake forms 24 hours prior to your scheduled New Patient appointment, otherwise we will have to re-schedule you for the next available new patient appointment.
The forms are located on a HIPPA compliant, secure link and are submitted directly to our office. These electronic forms allow us to create your intra-office electronic patient file, therefore eliminating the need for paper.
NEW PATIENT FORMS:
If you have Neck Pain or other related conditions such as: headaches, pain located from the skull to the top of the shoulders or radiating pain in the arms or hands; please select the Neck Pain Form below.
MOTOR VEHICLE ACCIDENT NEW PATIENT FORMS:
If you were RECENTLY involved in a Motor Vehicle Collision and are seeking treatment for a condition or symptoms DIRECTLY related to that collision please select the Motor Vehicle Collision History Form below. If you feel that your current symptoms may be as a result of a past motor Vehicle collision, that information can be discussed during your consultation and history.
Motor Vehicle Collision History
EXISTING PATIENT FORMS:
