THE BACK IN LINE NEWSLETTER
New Patient Intake Forms
If you have a problem from the chest up - please fill out the neck pain Q.
If you have an issue from the chest down - please fill out the low back pain Q.
New patient/pediatric/sports physical intake paperwork
| npintake_adult_99ncpoint.doc |
| new_patient_intake_pediatric_.pdf |
Neck/Low back pain questionnaires:
| Back Pain Questionnaire |
| Neck Pain Questionnaire |
| Sports physical - IHSAA |
Wellness Planning
If you are interested in issues that may be related to:
Low energy/fatigue, metabolism, nutrition, gut/digestion issues:
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Past Newsletters
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Aflac Forms
Effective 2/1/16. Due to the AFLAC policies needed HCFA forms, their will be a $20 admin fee for the time required to fill out these forms for each patient.
Patient's with AFLAC insurance policies should come with paperwork filled out prior to appointment and should demonstrate in detail the accident in which they are filing the claim. If patient requests a physicians signature several days after treatment was rendered, it will be evaluated on a case-by-case basis and the patient may see a processing fee or administrative fee.
Patient's with AFLAC insurance policies should come with paperwork filled out prior to appointment and should demonstrate in detail the accident in which they are filing the claim. If patient requests a physicians signature several days after treatment was rendered, it will be evaluated on a case-by-case basis and the patient may see a processing fee or administrative fee.
| Aflac Accident Forms |