Patient Forms 

Please print and fill out the Health History form and insurance information before coming to your appointment.​ Digital forms are also provided and must be submitted via e-mail. Further instructions on submitting digital forms are detailed here.

Arm, Shoulder or Hand – Printable PDF, Digital PDF

Low Back – Printable PDF, Digital PDF

Lower Extremities : Hip/Knee/Foot – Printable PDF, Digital PDF

Neck – Printable PDF, Digital PDF

Vestibular/Balance – Printable PDF, Digital PDF

Vertigo – Printable PDF, Digital PDF

Headache Disability- Printable PDF, Digital PDF

TMJ- Printable PDF, Digital PDF

•••Medicare Patients – Please fill out one additional form required by Medicare.

For your First Visit

In order for us to provide the best care for you, it is very important that you bring the following items to your visit:

•Photo ID
•Insurance information and card
•A list of your current medications
•Your referring physician and primary care physician’s name, address and phone number
•A referral/script from your physician​

Digital Forms Submission Instructions (two options)

  1. Fill out everything on the digital form and press submit at the bottom of the last page. From there, a prompt will appear and allow you to send the file via an email client. Follow the prompt and the form will be sent to the proper e-mail.

2) Fill out everything on the digital form and instead of pressing “submit” at bottom of the page, save the file to your computer, then continue to e-mail the file as an attachment to jeffreywoodspt@gmail.com for submission.