WE HAVE MOVED! Please Note the address on the top of the FORMS. Please see the map to the right. Thank You!

Forms You Will Need Before Your Visit
By filling your paperwork out ahead of time, you will ensure you get the full amount of time with the doctor. This helps our doctors to stay on schedule. If you have not filled out your forms by the time of your appointment, we may need to reschedule you to a later day.

In an effort to go paperless we have made our intake forms available online. To fill them out you will need Adobe Reader. Once you download the correct file please fill in as much of the forms as possible. Save the file as “LAST NAME FIRST NAME MMDDYY” and send to NWCCFRONTDESK@gmail.com . For further help see directions below. Thank you for your help in our efforts.

** First Begin by downloading the PDF file and saving it to your desktop by clicking on the “Save icon” which is the sixth icon from the right at the top of the PDF screen. Save the file using your “LAST NAME FIRST NAME MMDDYY” to a place you can easily find, such as your desktop. Next close the PDF screen and then reopen it from its saved location. **

For Older Versions of Adobe Reader…

  • Filling in form fields: Simply select the field you mean to address with the cursor and type your response.
  • “Drawing” on Pain Diagram: To the right of the Adobe Reader window there is a tab labeled “Fill and Sign.” Select this tab. Within this menu there is an option that says “Add Text.” Select this option. A box titled “Add Text” will appear in the middle of your screen. Next to the name of the font there is a box that allows you to change the color of the font. Select a color that can be easily discerned (i.e. red, orange, green etc.). Use the symbols specified in the legend to the left which can be found on your keyboard. Click over the area you are experiencing symptoms. Enter the correct symbol that describes your pain.
  • Adding signature: To the right of the Adobe Reader window there is a tab labeled “Fill and Sign.” Select this tab. Within this menu there is an option that says “Place Signature.” Select this option. There are several options for how you can transcribe your signature. Select one and use for all lines that require a signature.

For Recent Downloads of Adobe Reader…

  • Filling in form fields: Simply select the field you mean to address with the cursor and type your response.
  • “Drawing” on the Pain Diagram: To the right of the Adobe Reader window there is a tab labeled “Comment.” Select this tab. A new menu bar will appear at the top of the screen. Select the middle icon which is an uppercase “T.” A box titled “Add Text Comment” will appear in the middle of your screen. Next to the name of the font there is a box that allow s you to change the color of the font. Select a color that is easily discerned (i.e. Red, Orange, Green, etc.). Use the symbols specified in the legend to the left which can be found on your keyboard. Click over the area you are experiencing symptoms. Enter the correct symbol that describes your pain.
  • Adding signature: Close out of the comments tab by clicking the X in the upper right hand corner. Next click on the icon “Fill & Sign.” At the top of the window in the middle a stylus will appear. Click on this and select “add signature.” From here you can type your signature, draw your signature, or download a picture of your signature. Select one and use it for all lines that require a signature.

**Lastly, save the file by pressing the “Save” icon in the top right of the Adobe window. It will tell you that this file already exists and ask if you want to replace it? Press “OK.” Attach the file to an email and send to NWCCFRONTDESK@gmail.com . The subject line should read your “LAST NAME FIRST NAME MMDDYY”  **

 

Health Insurance or Cash
If you have never been a patient in our clinic, and you are not coming in for treatment as part of a car accident or work injury, please fill out these forms ahead of time. There is an additional form that must be printed with your paperwork, it is the LINK labeled FRI on the far right.  It is also available to fill out in the office. For these patients we are either billing Health Insurance or the patient is paying out of pocket at time of service. Please come in with your insurance card and photo ID ready.   Please check in with these forms completed 15 minutes prior to your scheduled appointment.

Motor Vehicle Insurance
If you are a new patient to our office and are coming as part of a motor vehicle accident claim, please fill out these forms ahead of time. Please make sure that your Personal Injury Protection policy is open and payable. There is an additional form that must be printed with your paperwork, it is the LINK labeled FRI on the far right.  It is also available to fill out in the office. Please come in with your motor vehicle insurance policy information, claim number and your photo ID ready. We also ask to take a copy of your health insurance card incase there are issues with your insurance company.  Please check in with these forms completed 15 minutes prior to your scheduled appointment.

Work Injury, L&I
If you are a new patient to our office and are coming as part of a work injury claim, please fill out these forms ahead of time.  Please bring in the billing information at the time of your appointment. There is an additional form that must be printed with your paperwork, it is the LINK labeled FRI on the far right. If you have not opened your claim yet, we will have you complete that paperwork when you come in. If you have already opened your L&I claim, please come in with your referral from your attending physician (the doctor who opened our claim), your L&I claim number, name of the L&I company we are to bill and your photo id.  Please check in with the referral and these forms completed 15 minutes prior to your scheduled appointment.

Massage
If you are a new patient to our office and are coming for a massage please have a prescription from your doctor for the massage care and fill out these forms ahead of time. If you do not have a valid prescription at the time of your appointment, we will collect payment at the time of service. Once we get your valid prescription we will bill your insurance and reimburse you when there is payment. There is an additional form that must be printed with your paperwork, it is the LINK labeled FRI on the far right.  It is also available to fill out in the office. Please check in with your prescription, unless you are paying out of pocket, and these forms completed 15 minutes prior to your scheduled appointment.  Please come in with your billing information: Health Insurance Card, MVA insurance information and your photo id. Payment is expected at time of service.

Health Insurance and Cash
If you have been a patient in our office, and you are not coming in for treatment as part of a car accident or work injury, please fill out these forms ahead of time. There is an additional form that must be printed with your paperwork, it is the LINK labeled FRI on the far right.  It is also available to fill out in the office. It is required that these forms are to be filled out if we have not seen you in the past 90 days.

Motor Vehicle Insurance
If you have been a patient in our office, and are coming as part of a new motor vehicle accident claim, please fill out these forms ahead of time. There is an additional form that must be printed with your paperwork, it is the LINK labeled FRI on the far right.  It is also available to fill out in the office. It is required that these forms are to be filled out if we have not seen you in the past 90 days.

Work Injury, L&I
If you have been a patient in our office, and are coming as part of a new work injury claim, please fill out these forms ahead of time. There is an additional form that must be printed with your paperwork, it is the LINK labeled FRI on the far right.  It is also available to fill out in the office. It is required that these forms are to be filled out if we have not seen you in the past 90 days.

Massage
If you are a returning patient to our office, and are coming for a massage, please fill out these forms ahead of time. There is an additional form that must be printed with your paperwork, it is the LINK labeled FRI on the far right.  It is also available to fill out in the office. It is required that these forms are to be filled out if we have not seen you in the past 90 days. Please check in with your prescription, unless you are paying out of pocket, and these forms completed 10 minutes prior to your scheduled appointment. Payment is expected at the time of service.