Intake Forms
Please print one Insurance Coverage form, No-Show Policy form, and HIPAA Privacy Policy form, sign, and bring to you first appointment.
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Click here to access the Insurance Coverage form, print it out, sign it, and bring in for your initial examination.
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Click here to access our No-Show Policy, print and sign it, then bring it to your initial examination.
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Click here to read the K-13 HIPAA Privacy Policy
Click here to access the acknowledgement form
Functional Scales
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Fill out this form for arm, elbow, hand, or shoulder pain.
Click here to print your Upper Extremity functional scale.
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Fill out this form for ankle, knee, hip, or leg pain.
Click here to print your Lower Extremity functional scale.
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Fill out this form for neck pain.
Click here to print your Neck Disability index.
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Fill out this form for back pain.
Click here to print your Low Back questionarre.
Records Release
If you would like our office to release medical records to another doctors office, law firm, etc, please print the medical records release form, sign, and send back to our office (we cannot legally send your records without a signed document). Note, there may be a charge associated with a records release.
For mail in requests, they must be sent to our St. Johns clinic at 1507 Waterford Parkway. If they are sent to our Portland address, we will not receive them.
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Click here to access the Records Release form. Print it out, sign it, include a fax number to where you would like it sent, and send it back to us for your records to be released.