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FORMS

Download and print these out to expedite your first visit.

New Patient Forms

• Clinic Privacy Policy (pdf)
• Patient Confidential Information (pdf)
• Patient Health History (pdf)
• Non-Medical Communications (pdf)

Additional Forms

• NDI Questionnaire – For neck pain (pdf)
• Oswestry Questionnaire – For back pain (pdf)
• Upper Extremity Functional Scale – For arm and shoulder complaints (pdf)
• Lower Extremity Functional Scale – For hip and leg complaints (pdf)
• Fibromyalgia Impact Questionnaire – For fibromyalgia sufferers (pdf)
• Quadruple Visual Analog Scale – For any kind of pain (pdf)
• Headache Disability Index – For all types of headache (pdf)