First Visit

Information needed...

You will need to bring

• Patient's Social Security Number

• If you are being seen for a work-related injury, you need to obtain a letter from your employer stating that this is a work-related injury. The letter must include a billing address.

• Insurance policy holder's date of birth

• Insurance policy holder's Social Security Number

• Insurance card or copy of both the front and the back of the card

• Insurance referral if required by your insurance company - See our list of companies

• List of medications the patient is presently taking

• Any x-rays you have had that pertain to this injury

You may Print blank forms and hand write in the information:

Patient History Form.pdf
Patent Information Form.pdf
   Dr. Watson Patient Information Form

Financial Policy.pdf (signed by the responsible party of the patient)

Medicare Beneficiary Authorization.pdf

Employer's Worker's Compensation Claim Acknowledgement.pdf
Liability Claim Acknowledgement.pdf

Acknowledment of Receipt of Privacy Practices.pdf

Spine Form - Dr. VanFleet, Dr. Williams and Dr. Mack

Physical Medicine form – Smucker

Dr. Ludwig Pain Sheet