Your First Visit
1) Privacy Policy
Medical Privacy Policy (HIPAA) download pdf
2) WHAT TO BRING WITH YOU ON YOUR FIRST VISIT
REGISTRATION FORMS
In order to properly diagnosis your problem, we ask that you fill out all forms and bring with you to your appointment.
- Patient Registration Form
- Patient Medical History Form
- Patient Questionnaire
- Pain / Numbness Diagram - SPINE PATIENTS
- Pain / Numbness Diagram - NON SPINAL PATIENTS
- Privacy Policy
- Acknowledgment of Receipt of Notice of Privacy Practices
- HIPAA Patient Consent for Use & Disclosure of PHI
- Financial Statement Policy
- Neck Index (use if you are being seen for neck/arm pain)
- Back Index (use if you are being seen for back/leg pain)
3) CONTROLLED SUBSTANCE POLICY (STATEMENT)
Controlled substance medications (i.e. narcotics, tranquilizers, and barbiturates) are very useful, but they have high potential for misuse and are therefore closely controlled by the local state and federal government. If you are prescribed a controlled substance, we ask that you agree to our controlled substance protocol. If you will not accept our protocol, we cannot treat you and you will need to work with another physician.
Agreement for Controlled Substance Prescription
Cautions Regarding the Use of Long Term Narcotics
4) Financial Statement Policy
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