Integrated Physical Medicine offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office. These let us know about the history and current state of your health. What questions, concerns and goals regarding wellness can we help you with? Please tell us! Download the necessary forms, print them out and fill in the required information. Then fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Intake Form
New Patient Health Questionnaire
Massage Intake Form
Body Contouring Intake Form
Workman’s Comp Form
Automobile Accident Form
Before & After Treatment
Patient Pain Assessment Forms
Back Pain - Upper and lower back pain
Back Pain (United Healthcare Policies) - United Healthcare requires its own unique forms
Neck Pain - Pain above the shoulders and below the head
Neck Pain (United Healthcare Policies) - United Healthcare requires its own unique forms
Headache/Migraines - (HDI)
Shoulder/Elbow/Wrist/Hand Pain - (DASH)
Knee/Ankle Pain - (LEFS)
Humana Insurance Policies - (PSFS)
Cigna (ASHLink) Policies - Initial Health Assessment Form
Regenerative Medicine Instructions
Platelet Rich Plasma Pre-Procedure Instructions
Platelet Rich Plasma After Care Instructions
Trigger Point Therapy Post Procedure Instructions
Human Cellular Tissue Products Instructions
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