Call Today:  (502) 241-1122

Save time by filling out your new patient forms before your exam.

Fill out General Patient Information and Insurance information online:   Intake Online Form Website

Print and bring in on your first visit:

New Patient Registration and History

General Pain Disability Index Questionnaire

Extra Forms if needed:

Possibly United Health Care:

Neck Pain Disability Index Questionnaire

Clinical Back Pain Questionnaire

DASH (Disabilities of the Arm, Shoulder, and Hand)

LEFS (Lower Extremity Functional Scale)

Possibly ASH:

Roland-Morris Low Back Pain and Disability Questionnaire

Oswestry Disability Index Questionnaire

Neck Pain Disability Index Questionnaire 2

Headaches:

Headache Disability Index (HDI)

Haven’t been in for awhile, progress exam or new incident forms:

Re-exam and patient update form