Forms

Forms

You may be asked to complete certain froms prior to your appointment.  You can find the appropriate forms below.  Click the requested form(s) to download.  Thank you!:

 Form 1 Welcome to Our Office

 Form 2 Registration

 Form 3 Informed Consent

 Form 4 Notice of Privacy Practices HIPAA

 Form 5 Upper Extremity Functional Index

 Form 6 Lower Extremity Functional Scale

 Form 7 Neck Functional Index

 Form 8 Low Back Functional Scale

 Form 9 Dizziness Handicap Inventory (DHI)

 Form 10 Health History

CALL US TODAY
(907) 745-7928

We Accept Insurance: Medical, Auto, Work Comp, VA. Blue Cross Preferred Provider
Master Card / Visa Accepted
No Finance Charge Payment Plans.