6781 N Thornydale Rd, Ste 215
Tucson, AZ 85741

520.742.2222

6781 N Thornydale Rd, Ste 215
Tucson, AZ 85741

520.742.2222

Forms

For your convenience and to save time in our office during your first visit, you can download a case history form in advance. Please complete the form appropriate for your type of payment. Forms are available in .pdf format – you will need Adobe Reader to open these files.

Form 1 Case History (click to download)
Entry form for all Self-Pay, Insurance, and Medicare patients.

Form 2 Personal Injury History (click to download)
Entry form for patients involved in motor vehicle accident or other type of injury where another party is responsible for payment.

Form 3 Release of Records (click to download)
Please print and provide us with a form for each Medical Provider or Facility where you have records related to the current health problem for which you are seeking treatment.

Transfer of Care

If you have recently relocated to the Tucson area and have received prior Chiropractic treatment, we can assist in an easy transfer of care. We will contact your previous Chiropractor directly to obtain records, x-rays, and discuss the method of treatment that worked for you. In accordance with HIPAA laws, we will need a signed release from you and the doctor’s address and phone number. Please call with your questions.

FORMS