Patient Info

Please complete one of the forms below prior to your first appointment.

The form below will have to be completed prior to your first appointment. We find it is substantially easier and time-saving if you type the information in the forms online, print the forms, and bring them with you to your appointment.

Use the upper body form if your complaints pertain to your upper body. Some examples in this category would be a headache, neck pain, thoracic pain, shoulder pain, arm pain, elbow/wrist/hand pain.

UPPER BODY FORM

Use the lower body form if your complaints pertain to your low body. Some examples in this category would be back pain (lumbar, sacral), buttock pain, pelvic pain, hip/knee/ankle/foot pain, leg pain.

LOWER BODY FORM

Insurance Companies We Accept
  • Aetna
  • Beech Street PPO
  • Blue Cross/Blue Shield (excludes Blue Cross/Blue Shield Advantage Plans)
  • CCN PPO
  • Cigna PPO and HMO
  • First Health-PPOAccountable Health
  • Galaxy Healthcare PPO
  • Great West/One Health Plan HMO and PPO
  • Healthsmart
  • Humana PPC and HMO (excludes HMO-X)
  • MedCorp, Mega Life PPO
  • Medicare Part B and Most Medicare Advantage Plans
  • Multiplan
  • Pacificare-HMO and PPO
  • PHCS
  • Pro-Net PPO, EPO POS
  • Tricare
  • SHP Seton Employees (Tier 2)
  • United Healthcare HMO, PPO, POS, EPO
  • USA PPO

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