FORMS

Please Note:  Some of the fillable PDF's are not functioning properly.  As a result, you may not be able to complete some of the areas requesting information on your computer.  You can either request we email you the forms which are working properly and can be completed on your computer, or you can complete the forms, or the portions of the forms, that are not functioning properly by hand.​  Thank you for your understanding as we work out the bugs with the software provider.
For your convenience, we have placed all the forms you might need on this page,  If you have any questions as to which ones you should complete, or experience any difficulties with the forms, please give us a call at 745-7928.

New Patients Being Seen For A Pain Related Complaint
Please complete the registration packet on your computer if possible.  Print and bring with you to your initial appointment.  If you are being seen for Peripheral Neuropathy, please complete the Upper & Lower Peripheral Neuropathy Functional Index.  You only need to complete the Peripheral Neuropathy form that applies to you.  If you are being seen for neck or back pain, please complete the appropriate neck or back pain functional index.  We have included a copy of our books Turning Point - Integrative Solutions for Chronic Pain and Breast Thermography - What Every Woman Must Know Before Having a Breast Thermogram.




















Existing Patient, Same Complaint(s) Not having Been Seen For Treatment In More Than 2 Months.








New Patients Being Seen For A Women's Health Related Complaint
If you are being seen for a Women's Health related concern, please complete the following forms.  Please complete the registration packet on your computer if possible.  Print and bring with you to your initial appointment.  We have included a copy of our two books we thought you might find useful (Breast Thermography and Turning Point)











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Breast Thermography 
To be completed by anyone obtaining a breast thermogram.  If this is your first breast thermogram at our clinic, please complete the Initial Breast Thermogram forms.  If you have received a breast thermogram from us in the past, complete the Follow-up Breast Thermogram forms.  If you need to update your registration information, complete the Initial Breast Thermogram forms.  We have included an article you might enjoy titled Mammography vs. Thermography.  We have also included a copy of our two books; Breast Thermography - What Every Woman Must Know Before Having A Breast Thermogram & Turning Point - Integrative Solutions for Chronic Pain.







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PCA (Patinet Condition Assessment)

The PCA form is completed prior to each appointment (other than thermography related appointments).  A form will be available at the office or you can complete it at home.  The form should be completed with a couple hours of your appointment.  Two forms are provided below; one is a fillable PDF that can be completed on your computer and one is a standard PDF you can print and complete.  Be sure to bring it in when you come in for your appointment.







Miscellaneous Forms

If you are an existing patient with a new concern, please complete the Medical Intake form.  If you need to update your registration information (name, address, insurance, etc., please complete the Registration Update form.


Registration Forms
Neck Functional Index
Thermography Pre-Imaging 
Back / Low Back Functional Index
Peripheral Neuropathy Lower Extremity
Peripheral Neuropathy Upper Extremity
Turning Point Book
Breast Thermography Book
Existing Patient
Registration Forms - Women's Health
Menstrual / Menopause Fucntional Index 
Breast Thermography Book
Turning Point Book
Breast Thermography - Initial
Breast Thermography - Follow Up
Mammography vs. Thermography
Breast Thermography Book
Turning Point Book
Patient Condition Assessment
Registration Update
Medical Intake