Most of the forms you might be asked to complete can be found on this page.

In order to better serve you, there are several items of information we will need before you are seen by the doctor. This information will be used by the physician to help evaluate your condition as well as to identify the best course of treatment. It is very important that you provide accurate information regarding your medical history, medications and allergies.

We will also collect information that will allow us to bill your insurance. If you were injured in an accident we will need information to determine the proper party to bill.

All patient information is safeguarded in accordance with federal HIPAA (Health Information Portability and Accountability Act) guidelines.

Privacy Policy

 

PolĂ­tica de Privacidad

 

 

Please download and complete the applicable forms, below.

Doctor-specific Forms

Dr. Clifford, Dr. Frazho or Dr. Gebhard Patient History for Back Disorders
Dr. Clifford, Dr. Frazho or Dr. Gebhard Patient History for Neck Disorders

Physical Therapy Forms

Functional Assessment Questionnaire

Patient Satisfaction Survey

Records Release Request

Records Release Form