Patient Info / Forms

To help get you started on your path to recovery, please print and fill out the following registration forms. These forms are in Adobe PDF format. You can get a free copy of Adobe Acrobat Reader here. Please be sure to bring all forms completed with you to your first appointment.

• Patient Intake Form
• Medical History and Medications
• Consent to Treat and Patient Financial Responsibility
• Patient Financial Policy
• Receipt of Privacy Practices
• HIPPA Statement
• Consent to Treat a Minor
• Insurance Coverage Waiver

If instructed by the office, please print out the relevant form:

• Back Index
• DASH
• Neck Index
• LEFS
• Patient Summary
• PFDI 20

Your First Visit Checklist

Please bring the following materials with you for your first visit:

• Registration Forms, above
• Prescription
• Insurance Card
• Drivers License or Picture ID

For more information, Contact Us at your nearest Carlson ProCare Location.