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 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!