Forms

In order to make your office visit as efficient as possible our office forms have been provided to you below.  If you'd like you can print and complete the forms prior to your visit.  They are provided in Adobe Acrobat format.  If you don't have Acrobat, you can receive your free copy here.

Appointment checklist

	Please complete both forms in Section I below and present them to our receptionist at the time of your appointment
	Please bring any medical records to your appointment as well as the actual x-ray films, MRI films or CT scans that you have had recently.
	Your current insurance card is required and will be copied at the time of your 1st visit.
	If a referral authorization is needed for your appointment, it is your responsibility to bring a written authorization with you.
	If your insurance requires a co-pay this is expected at the time of checking in.
	print checklist

Section I

	Insurance Carrier and Employer Information Form
	Medical History

In addition to the forms needing filled out in Section I.  For your initial scheduled appointment, you may also be instructed to fill out one or more of the following forms:

Section II

	Shoulder History Form
	Patient Pain Drawing Form - Back
	Patient History Form - Back

Privacy Practices

Notice of Privacy Practices

For more information about our participating insurance plans, medical policies, payment policies and hospital affiliations, visit Our Practice page.  For appointment information, please visit our Appointment page.