Patient Intake Forms
 

Patient Intake Forms

Click on the icons below to download our new patient forms as a PDF Document.

Once downloaded, print, fill in your information and bring with you to your next office visit. Your answers to these questionnaires will help to find the cause of your condition. Thank you for taking the time to complete them.

New Patient Intake Form

for everyone


Established Patient Intake Form

For existing patients


Notice Of Patient Privacy

Privacy Info


Consent to use PHI

PHI Consent Info


Metabolic Assessment Form

For those with metabolic issues (thyroid, autoimmune, diabetes, etc)


Motor Vehicle Accident Questionnaire

Motor Vehicle Form

We are proud to serve the Tri-State area, including Evansville, Henderson and Southern Illinois

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ABOUT US

Musculoskeletal Conditions
  • Headaches
  • Neck Pain
  • Low Back Pain
  • Carpal Tunnel
  • Tennis Elbow
  • Shoulder Pain
  • Rotator Cuff
  • Knee Pain
  • Plantar Fasciitis
Condition Specific Services
  • Diabetes
  • Thyroid / Hashimoto’s
  • Neuropathy / Foot Tingling
  • ADD/ADHD
  • Anxiety / Stress / PTSD
  • Memory Loss
  • Fatigue
  • Brain Injury
  • Depression
  • Fibromyalgia
  • Insomnia / Sleep Issues
  • Learning Disabilities
  • Autism
  • Epilepsy / Seizures
  • Addiction
  • Stroke

Your Journey to a Healthier Life Starts Here

Are you ready to take control of your health and get the answers you are looking for?