NEW PATIENT FORMS

Prior to you first visit please read the following information regarding HIPAA and ACPT’s financial policy. You will be asked for a signature indicating that you have read and accept these policies prior to your visit. 

Forms related to injury or pain location

If you will be seen for a condition effecting one of these body regions please fill out the corresponding form. 

Neck (Cervical Spine) or Headache
Middle and Low Back (Thoracic Spine, Lumbar spine)
Shoulder, Elbow, Wrist or Hand
Hip, Knee, Ankle, or Foot

 Please be aware that some insurance companies require extra paperwork which is specific to certain policies. If you have one of these policies you will be asked to fill out 1-2 more forms prior to your first visit.

Dizziness/Vertigo
Headaches

CLINIC LOCATION

4045 Wadsworth Blvd. Suite 10

Wheat Ridge, CO 80033

Tel: 303-940-1611

Fax: 303-432-2296

Current (Temporary) Hours:

Mon           8:30am-6:30pm
Tues          8:00am-5:00pm
Wed           8:00 am-4:00pm
Thurs        8:30am-6:30pm
Fri             8:00am-6:00pm

CONTACT

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