Forms and Documents

Forms

	Patient History Form Detailed patient history questionnaire to help us better understand and diagnose your condition.
	Patient Registration Form This is a basic patient registration form you should have with you when making your first visit to one of our offices.
	Back Pain Questionnaire Low back pain disability questionnaire is designed to give us information as to how your back or leg pain is affecting your ability to manage in everyday life.
	Neck Pain Questionnaire Neck pain disability questionnaire is designed to give us information as to how your neck or arm pain is affecting your ability to manage in everyday life.
	Patient Questionnaire This patient questionnaire is to help keep track of how well you are able to do your usual activities.
	Consent Form for Privacy Practices This is a patient consent form for the use and disclosure of protected health information.

Documents

	Prescription Agreement for Narcotics This is an agreement to protect both you and the physician to establish guidelines for proper and controlled substance use.
	Privacy Practices A notice of privacy practices adheard to at Atlantic Spinal Care.