New Patients
WC and PI Patients
Additional Items
1. Financial Information and Informed Consent
2. Patient Intake Form and Health History
1. Personal Injury Intake
Form
2. Personal Injury Insurance Log
3. Medicare Financial Information Chiro
4. HIPPA Information
5. TOS Financial and
Informed Consent
3. Pain Questionnaires
4. Motor Vehicle Accident Form
5. Attorney and
Insurance Lein
6. Assignment
Authorization
1. Patient's Guide to Insurance
2. Dry Needling Packet
3. Records Release