Private Insurance

• New Patient Information
  
• Patient History: Health history information for all new patients to fill out and bring in.
  
• Functional Capacity Evaluation: A form for all Private Insurance and Worker's Compensation patients to fill out before the first visit, and periodically thereafter. Recommended, but not required for self-pay clients. Please note: the instructions are at the end of the form.
  
• HIPAA privacy statement: A summary of the ways we protect your private health information. Read, then follow the Acknowledgement link to sign.
  
• Superbill Payment Agreement: Please fill out this form in order to be provided with a superbill to send to your private insurance.