Patient Intake Forms

All paperwork is available in our office.  We encourage you to have the appropriate intake form competed upon arrival.  There may be additional forms upon check-in based on individual insurance authorization requirements and mandated reporting measures.

General Intake Form (pdf)


Balance and Osteoporosis Intake Form (pdf)


Signature Pages- All Patients (pdf)


Blank Script

Although referrals are often not required, you may bring this form to your doctor to fill out and bring to your appointment.  

We prefer to have a doctor on file with whom we can coordinate your care.  

Your doctor may also fax a referral/ order to us at (480) 272-9369.

Blank Script (pdf)


HIPAA Privacy Notice