Registration Forms

For your convenience, please fill out and submit your secure intake forms by clicking on the links below. If you are unsure which forms to select please call 520 648 3132. The completed forms will be sent to us automatically. Be sure to bring your insurance cards and doctor’s referral to the first appointment.

Only fill out registration forms if you have a scheduled initial appointment.

Please do not print the forms below.

ALL PATIENTS

• Registration Form
• Medical History Questionnaire
• Financial Agreement

Click below to review our Privacy Policy ( No additional signature required)

• Privacy Policy

Click below to sign and submit a Records Release

• Records Release

Please complete one of the following forms. Select the form that corresponds to your injury/pain. If you are unsure which form to select please call 520 648 3132.

 
– Neck Disability Index Form (NDI)

– Disability of the Shoulder, Arm, or Hand Form (Quick Dash)

– Modified Oswestry Low-Back Disability Index Form (ODI/MDQ)

– Knee Outcome Form (KOS)

– Lower Extremity Functional Index Disability Form

– Dizziness Handicap Inventory – MIPS
 

DRY NEEDLING PATIENTS

– Dry Needling Consent Form