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Forms

Registration Form    Checklist for Office Visit

Help Us Help You    Privacy & HIPAA Notice

Checklist: Consider these for your office visit

1. Insurance card (with policy holders information)

1. Date of birth of policy holder

2. Social security number of policy holder

2. Referral from primary care physician (if necessary)

3. Co-payment

4. Drivers license or photo ID

5. X-rays and other studies such as MRI’s, CT scans, bone scans, etc. with corresponding reports of the area(s) pertaining to your office visit.

6. Any other information regarding your injury that would assist the physician or expedite your claim.

7. A list of the medications you are taking along with the strength and dose.

8. The name and phone number of an emergency contact other than someone who resides with you.

9. If the patient is a minor (person under the age of 18) they must be accompanied by a legal guardian or have written permission by their legal guardian to be treated.

Checklist: Printable version

Office Locations & Driving Directions

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