Patient Registration Forms
For the convenience of our patients, our forms may be downloaded, printed and completed prior to the initial visit. All of the following forms are downloadable by clicking on the title of the form.
The official government HIPPA (Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) Policy is available for your review. Click here to view our HIPPA Policy Statement Form. There is no need to print this form.
THERE ARE FOUR FORMS THAT MUST BE COMPLETED BY ALL OUR PATIENTS:
1. Patient Information Form
2. Financial Responsibility Form
3. Privacy Act Receipt Form
4. Pain Scale Form
MEDICARE PATIENTS MUST ALSO COMPLETE THIS FORM:
Medicare Cap Form
MOTOR VEHICLE ACCIDENT PATIENTS MUST ALSO COMPLETE THIS FORM:
Motor Vehicle Assignment of Benefits Form
MASSAGE THERAPY PATIENTS SHOULD COMPLETE THESE FORMS:
1. Patient Information Form
2. Privacy Act Receipt Form
3. Pain Scale Form
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