Patient Forms

 In order to make the initial visit go quicker, please print these forms out and fill in all the necessary information that applies to you. This will allow us to pre-register you in our computer system.

Once this is complete, fax back to our office at (623)773-0300 or bring these forms with you to your appointment:

 

New Patient Questionnaire/Welcome Form (Download PDF)


Pain Chart Form (Download PDF)


Notice of Privacy Form (Download the HIPAA PDF form)


Auto/Work Related Accident Form (Download PDF)

 

Make a copy of your insurance card Referral form (if referred by another provider)

Any related x-ray PHOTOS films or test results (if provided)

patient-info-right

Our office strives to provide you with a pleasant experience.
  • A thorough exam to determine your issues, needs, and causes of discomfort or pain.
  • Assessment of the entire body, considering all areas of body alignment and the source of problems.
  • Treatment options are covered with you in detail including additional consultation and services.
  • Treatment costs are covered so you know your options for care.
  • Scheduling of your next appointment is done before you leave the office to help "get you back in the game of life".

If we are unable to help you, we will help refer you to other resources and specialties.

 

Major Medical Insurance:

  • First Health Group
  • Integrated Health Plan
  • Blue Cross Blue Shield PPO
  • Auto Insurance
  • Med Pay/Liability
  • Worker's Compensation
  • Medicare

 

 



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