Want to save 20 Minutes on your First Visit?
**FILL OUT IF YOU WERE INVOLVED IN AN AUTOMOBILE ACCIDENT ALONG WITH THE AUTHORIZATION AND RELEASES FORM BELOW**
Vehicle Accident Information
**ONLY FILL OUT IF CURRENT OR PREVIOUS PATIENT**
**PLEASE ONLY COMPLETE THIS FORM IF YOU HAVE NOT LOGGED INTO OUR PATIENT PORTAL (MedicFusion) AND COMPLETED IT THAT WAY. THIS WILL PROVIDE US WITH THE CLINICAL INFORMATION ABOUT YOUR CONDITION.**
New Patient Health History Form for Cash & Insurance Patients-Required
**ALL PATIENTS NEED TO COMPLETE THIS FORM**
Authorization and Releases
** IMPORTANT NOTICE **