Here are patient forms all available for you to download, print, fill out and then return to our office. We’ve also included a file of important patient information for you to review.

You’ll need Adobe Acrobat to open portable document files (PDF). If you don’t yet have Acrobat, you can download Adobe Acrobat Reader for free from Adobe’s website.

New Patients:

Patient Intake Form

Counterstrain Self Pay Intake

Informed Consent

Payment, Consent and Policy Form

Notice of Privacy Practices

Neck, Shoulder and Upper Back:

Upper Body Form

Lower Back, Pelvis and Legs:

Lower Body Form (Quebec Pain Scale)

Pelvic Floor Problem (including incontinence):

Lower Body Form (Quebec Pain Scale)

Pelvic Floor Impact Form