Advanced Spinal Care Center -

Office Forms

Posted By Dr. Michael Polsinelli, DC On February 20, 2007 @ 7:06 am In | Comments Disabled

To save time, ed [1] patient [2] print out these forms and fill out before the first visit (make sure that you remember to bring the filled out forms for the first visit).  You may also fax the office forms to us at 440-943-6716.

Patient Intake [3]

Accident Questionnaire [4] (If your had an auto or work injury, fill this out also.)

HIPPA Privacy Policy [5] (Save for your records)

Hippa Signature Form [6] (Please print and sign)

All forms are in .pdf format. You can download Adobe Reader Here [7], and Foxit Reader Here [8].

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[3] Patient Intake:

[4] Accident Questionnaire:

[5] HIPPA Privacy Policy:

[6] Hippa Signature Form:

[7] Adobe Reader Here:

[8] Foxit Reader Here:

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