Forms
Please fill out and bring the relevant forms when seeing your therapist for the first time, or if it's been a year since your last visit.
New Patient Forms for Adults (18 or older):
- General Information (.pdf)
- Health History (.doc) or (.pdf)
- Family Records Release Form (.docx)
- HIPAA Form
New Patient Forms for Children (17 or younger):
- General Information (.pdf)
- Health History (.docx) or (.pdf)
- Family Records Release Form (.docx)
- HIPAA Form (.pdf)
If you are insured by John Deere Health Care or United HealthCare, click below for an additional form. You may refuse to fill out this form without any loss of benefits but we are required to send it in so please bring it with you, blank or filled out.