**There is now a $25.00 fee for any missed appointment**

If you are experiencing Low back pain, please print and fill out the Low Back Pain Charts 1 & 2.  If you are having neck pain, please print and fill out the Neck Pain Chart.  If you are experiencing headache pain, please print and fill out the headache form. If you having pain in all three areas, please fill out all 4 forms. 
If you are experiencing Low back pain, please print and fill out the Low Back Pain Charts 1 & 2.  If you are having neck pain, please print and fill out the Neck Pain Chart.  If you are experiencing headache pain, please print and fill out the headache form. If you having pain in all three areas, please fill out all 4 forms. 
If you are experiencing Low back pain, please print and fill out the Low Back Pain Charts 1 & 2.  If you are having neck pain, please print and fill out the Neck Pain Chart.  If you are experiencing headache pain, please print and fill out the headache form. If you having pain in all three areas, please fill out all 4 forms. 
If you are experiencing Low back pain, please print and fill out the Low Back Pain Charts 1 & 2.  If you are having neck pain, please print and fill out the Neck Pain Chart.  If you are experiencing headache pain, please print and fill out the headache form. If you having pain in all three areas, please fill out all 4 forms. 

**Please print and fill out all forms to the left, as they are mandatory for your insurance. 

*All patients: for email and text alerts/reminders please complete the purple form below*

If you are experiencing Low back pain, please print and fill out the Low Back Pain Charts 1 & 2.  If you are having neck pain, please print and fill out the Neck Pain Chart.  If you are experiencing headache pain, please print and fill out the headache form. If you having pain in all three areas, please fill out all 4 forms. 

Skip the paperwork in the office,

                                         download our new patient forms!

 Insurance Color Codes:

 Empire/United Health: GREEN

 Univera: BLUE

 Workers Comp: RED

 Motor Vehicle/Personal Injury: WHITE

All Other Insurances/Cash:YELLOW