New Patient Information

Please allow approximately twenty minutes to complete paper work before your first appointment.  For your convenience, all of the required forms can be found under Patient Forms.  Please complete the Billing Policies; this form includes elaborate details of most policies and procedures of this practice.  The second form is the The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”); it goes into great detail about how your medical records are used and protected.

The third form is your Demographic Information and insurance information; for worker’s compensation or auto accidents, this is where you need to indicate your adjusters and/or attorney information along with a claim number.  Workers compensation patients will be required to provide their regular health insurance information along with their claim number as a “back-up plan” as it will be submitted if your claim is denied for any reason.

Next, please complete the Medical History indicating pre-existing conditions, previous surgeries and current medications.  Please provide the name and dosage of each medication you are taking.  Lastly, there are the Back Pain, Neck Pain, and Extremity forms.  Please choose the appropriate form(s) coinciding to the location of your pain.

For example for an injured back and left leg please fill out the Back Pain for the back and the Extremity form for the left leg.  Please note the exact date of when your symptoms started.

Our practice is equipped with NextGen; we have the ability to share lab results, x-ray reports, diagnoses, medication histories, allergies, hospital discharges, emergency room summaries and other pertinent data with other practices using this system.  Please complete the Calvert Health Information Exchange only if you wish to “opt out” of this service and return it to our front desk staff.  This form explains the benefits and procedures of the health information exchange.