Forms

To expedite the registration process please print, fill out, and bring the following forms associated with the issue for which you are seeking treatment to your first visit.

All New Patients:

Notice of Privacy Practices

Patient Health Questionnaire

Medications

Choose from the following based on the issue for which you are seeking treatment:

Neck Index

Back Index

Upper Extremity Functional Index (shoulder, hand, etc.)

Lower Extremity Functional Index (knee, foot, etc.)

Dizziness Handicap Inventory - Screening Version (DHI-S)

Vestibular Health Questionnaire

If none of the above apply to your issue, please fill out:

Optimal Instrument Difficulty

If you are 65 or older:

Fall Risk Assessment

If you are 18 or older:

Well Rx Form

If you are 12 or older:

PHQ-9 Patient Health Questionnaire

If you were not referred:

Patient Attestation Form