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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. 

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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)
Headaches
Hip, Knee, Ankle, or Foot
Shoulder, Elbow, Wrist or Hand
Dizziness/Vertigo

 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.

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