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Follow and Review Us

Back to Health Clinic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

Motor Vehicle Crash / Workers Comp Patients -

  1. New Patient Health History Form
  2. Financial and Billing Policy
  3. Health Records Intake
  4. Low Back Disability Questionnaire
  5. Neck Disability Index
  6. Notice of Privacy Practices
  7. Information Release
  8. Visual Analog Scale
  9. Informed Consent

Private Insurance / Self Pay Patients -

  1. New Patient Health History Form
  2. Financial and Billing Policy
  3. Health Records Intake
  4. Notice of Privacy Practices
  5. Information Release

No-Show Policy

Consent to Treat a Minor Child

Doctor's Lien



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