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Online Forms

Integrated Physical Medicine offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

Patient Intake Form

Patient Health Questionnaire

Massage Intake Form

Workman’s Comp Form

Automobile Accident Form

Patient Pain Assessment Forms

Back Pain - Upper and lower back pain

Back Pain (United Healthcare Policies) - United Healthcare requires its own unique forms

Neck Pain - Pain above the shoulders and below the head

Neck Pain (United Healthcare Policies) - United Healthcare requires its own unique forms 

Headache/Migraines - (HDI)

Shoulder/Elbow/Wrist/Hand Pain - (DASH)

Knee/Ankle Pain - (LEFS)

Humana Insurance Policies - (PSFS)

Cigna (ASHLink) Policies - Initial Health Assessment Form 

This lets us know the history and current state of your health.  What questions, concerns, goals, regarding wellness can we help you with?  Please tell us!



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