PATIENT REGISTRATION FORMS
Appointment Procedure
Before an appointment can be given, our office has to receive the following forms:
- MRI Report less than six months old
- Patient contact information
- Doctors notes
- Referral if appropriate
- Insurance cards
After the above items are received, the patient will receive a phone call for an appointment time and date.
Patients will then:
- Print the Patient Registration Forms (below) and Complete them.
- Bring to the appointment
- Patient Registration Forms
- MRI films
- Insurance cards
- Driver license
- Copay
Patient Information Sheet
Spinal And Health History
Show Us Where It Hurts
Agreement As To Resolution Of Concerns
Consent to the Use and Disclosure of Health Information
Legal Claims
Workers Comp-Auto Information
Patient Responsibility Policy
Notice of Privacy Practices Acknowledgment
Notice of Privacy Practices Brochure
