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New Patient Forms

Select your doctor's name below to navigate to their forms required for your first visit to the practice. To save time, please fill out forms and bring them with you to your appointment.

Dr. Baldy&Houfek
Dr.Lancaster&Sullivan Dr. Case-Luca Dr. Ferez Dr. Houfek
Dr. Krasnov&Houser Dr. Presas Dr. Ransone Dr. Redd
Dr. Schmid Dr. J. Smith Dr. S. Smith Dr. Wallace


Dr. Baldy

Submit Form Online


Dr. Case-Luca

Submit Form Online


Dr. Ferez

Initial Consultation Form

Personal Health History Form

Neck Index Form

Back Index Form


Dr. Houfek

Submit Form Online


Dr. Krasnov

New Patient Forms

Work Injury Form

Personal Injury Form


Dr. Presas

New Patient Forms

Personal Injury Form

Work Injury Form


Dr. Ransone

New Patient Intake Form

Assignment of Benefits Form

MD Communication Form

Disclosure Authorization

Informed Consent Form

Insurance Assignment Policy

Oswestry Disability Form

Review of Systems Form

Headache Index Form

Neck Pain Index Form

Personal Injury Information Form

Personal Injury Questionnaire Form


Dr. Redd

New Patient Health History Form

Patient Information Update Form

Auto Accident Injury Form

Personal Injury Form


Drs Lancaster and Sullivan

New Patient Form


Dr. John Smith

New Patient Forms


Dr. Sean Smith

New Patient Forms


Dr. Schmid

New Patient Health History

Consent to Treat Form

HIPAA Policy Form

Insurance Assignment Form

MD Communication Form

Direct Payment Form

Auto Accident Questionnaire Form

Lower Back Questionnaire Form

Neck Disability Questionnaire Form

Personal Injury Information Form


Dr. Wallace

Submit Form Online

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