Skip to content

New Patient Forms

We offer our new patient forms online so you can download and complete these forms in the convenience of your home prior to your first appointment. Please call us if you have any questions. (817) 421-4775

All New Patients Must Complete These Forms Online in Advance of Their Appointment.

Please call the office @ 817-421-4775 to have the forms sent to you.

pdf iconAuto Accident Paperwork (Please print, complete, sign and bring with you to your first visit)

pdf iconDoctor’s Lien (For 3rd Party or Auto Accidents WITH Lawyer – if using your own auto insurance (PIP) you do not need to fill this out)

pdf iconNeed to send records to/from our office? Click HERE

UHC New Patients ONLY: Please PRINT and fill out these forms IN ADDITION to the online New Patient forms listed above:pdf iconUHC New Patient Summary Form-Must Completepdf iconUHC-Back Index-Must Completepdf iconUHC-Neck Index-Must Completepdf iconUHC-Keele STarT Back Screening Tool-Must Completepdf iconUHC-Lower Extremity Functional Scale (LEFS)-Complete if Applicable

pdf iconUHC-Disabilities of the Arm, Shoulder and Hand-Complete if Applicable

Free AdobeReader®

Get adobe readerEach form is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.