Patient Forms

New Patient Paperwork

All patients who are new to CPR will need to complete the following:

CPR Consent & Billing Practices

CPR Health History

CPR Pain Self Evaluation

If you are seeing a Chiropractor you will need to complete the following:

CPR Consent to Chiropractic Treatment (To be completed in addition to, not in lieu of the CPR Consent)

CPR Chiropractic Supplemental Questionnaire

If you are being seen regarding a work related injury or a motor vehicle accident you will need to complete one of the following forms as applicable.  These supplemental forms apply to both Physician and Chiropractic Patients:

CPR Workers Compensation Supplemental Questionnaire

CPR MVA Supplemental Questionnnaire

If you had a procedure done in one of the surgery centers, you should have been given a pain diary to complete.  If you did not receive one, or if you need another copy, you can print one here:

CPR Pain Diary

Medical Records Release

Medical Records Release

Privacy Policy/HIPAA

CPR Notice of Privacy Practices

Acknowledgement of Receipt of CPR Privacy Practices





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