Pre-Treatment Forms
Which forms do I need?

Patient Intake Form		All patients need this form
Financial Policy Form		All patients need this form
Medicare Questionnaire		If you have Medicare Insurance or replacement
Cervical Functional Assessment		If your diagnosis is for cervical, neck, upper back, thoracic
Lumbar Functional Assessment		If your diagnosis is for lumbar, low back, sacrum, pelvis, sciatica
TMJ Functional Assessment		If your diagnosis is for TMJ
Neuromuscular Functional Assessment		If you have had a head injury or stroke
Upper Extremity Functional Assessment		If your diagnosis is for rotator cuff, shoulder, elbow
Lower Extremity Functional Assessment		If your diagnosis is for knee, meniscus, collateral ligament, patella, quad, calf, hip area, ankle sprain, plantar faciitis, Achilles tendonitis or bursitis
Hand Functional Assessment		If your diagnosis is for carpal tunnel, wrist, fingers
General Functional Assessment		If you have several diagnoses that cover several areas of your body