Patient Forms

Welcome to our practice!!!

We would like to take a moment to personally welcome you to our practice.  Your expression of confidence is well appreciated and a sincere effort will be made to satisfy your physiatry needs.

As your physiatry provider, it is our responsibility to deliver the best health care possible.  Our physiatry providers and staff sincerely trust that you will be satisfied with the service we will render.

Please complete the following registration forms and patient questionnaire(s) and bring them with you at the time of your appointment. Should the appointment time or date be inconvenient for you, we kindly ask that you call the office as soon as possible or at least 24 hours prior to the appointment to reschedule or cancel.

Patient Registration Form

Patient Questionnaire

Authorization for Release of Health Information

We would also like to remind you to bring along with you…

  •  Health Insurance Card or Worker’s Compensation Information.
  • Insurance referral from your primary care physician (if part of HMO).
  • X-Ray/MRI/CT scan films and reports (request copies of films/CD 24 hours prior to pick up)
  • We do not bill car insurances for motor vehicle accidents.
  • Self-pay accounts should read the financial policy on the registration packet carefully regarding initial payment requirements.

Please feel free to contact the office should you have any questions.

Once again, it is our pleasure to provide our professional services to you.