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New Patient Forms

New Patients

Please print and fill out the necessary new patient forms below:

• New Patient Intake Form – download here

• Quadruple Visual Analogue Scale – download here

• Activities of Daily Living – download here

• Health Background – download here

 

IN ADDITION TO THE ABOVE FORMS:

 

Please Fill out the following forms if you have:

• Back Pain – download here

• Neck Pain – download here

• Disabilities of the Arm, Shoulder, and Hand – download here

• Lower Extremity – download here

 

Existing Patients

Please fill out the forms below:

• Progress Evaluation – download here

• Quadruple Visual Analogue Scale – download here

 

Please Fill out the following forms if you have:

• Back Pain – download here

• Neck Pain – download here

• Disabilities of the Arm, Shoulder, and Hand – download here

• Lower Extremity – download here

 

Pediatric Patients – Please fill out the forms below:

• Consent to Treat a Minor – download here

• Patient Intake Form – download here

• Pediatric History – download here

 

Motor Vehicle Patients – Please fill out the forms below:

• New Patient Intake Form – download here

• Motor Vehicle Patient – download here

• Quadruple Visual Analogue Scale – download here

• Activities of Daily Living – download here

• Health Background – download here

 

Please Fill out the following forms if you have:

• Back Pain – download here

• Neck Pain – download here

• Disabilities of the Arm, Shoulder, and Hand – download here

• Lower Extremity – download here

 

“Dr. Tammy is the first doctor to actually design a plan to fix me! With an affordable care plan and a series of exercises, I have gotten to a point in my life where I feel pain free for weeks at a time. I am confident that this time frame will increase as I have only been going to Dr. Tammy’s office for 2 months. This has been an amazing increase to my quality of life!” – Tina
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