Substance Survey Form
It is very important for us to know about the medications and supplements you take, as well as some of your bad habits as well: how much coffee you drink, whether you drink soda or diet soda, eat chocolate... We want to know about all the things you take in to your body!
RAND Health Medical Outcomes Study:
36-Item Short Form Survey Instrument
Developed by the RAND Health Organization, this tool is a little tedious, but very important for us to determine your health status when you begin care, measure your improvements as you complete care, and map out the areas of continuing concern for your ongoing care. Please take the time and trouble to complete this form as carefully and as accurately as you can. This may be the most important form you fill out, after the Case History Form!
Visual Analog Pain Scale
The trend in Health Care today is a concept called, "Evidence-Based Care". In keeping with that trend, we ask your indulgence in filling out these next two forms: The Visual Analog Pain Scale, and The Functional Rating Index. If your insurance company is to consider reimbursement for your expenditures in our office, they will require an assessment tool such as these that, "prove" the necessity and effectiveness of care. We will do what we can to help you recover what you are due.
Financial Policy
We are committed to providing you with the best possible care, and affordable prices. Your clear understanding of our Financial Policy is important to our professional relationship. Please ask if you have any questions about our fees, Financial Policy, and your responsibilities.
HIPPA Privacy Information Form
In today's information overload culture, many protections to privacy have been incorporated into our lives. This two page form is one more required bit of information that you must be aware of concerning our responsibilities in communicating with you and your rights in controlling who may have access to your Personal Health Information.
Informed Consent To Chiropractic Care
Our sincere goal is to help you have clear understanding of Chiropractic Health Care and the functional status of your health. This standard form is to be signed once you feel confident that we have evaluated you and your condition thoroughly enough to administer chiropractic care with confidence, knowing that you have no Relative Contraindications or Absolute Contraindications to Chiropractic Manipulative Therapy.