PATIENT FORMS

Thank you for your interest in becoming a Back and Body Medical patient. Prior to making an appointment with us, please download and print out our Patient Information form and complete it to the best of your ability. Please bring the completed form with you to your appointment. Save time in the office and fill these out before your first visit!

• New Patient Forms

Medicare Patients should fill this form in as well as the New Patient Forms.

• New Patient ABN Medicare

You can also find applicable insurance forms by provider below. Click on the one that applies to view and download.

Again, thank you for your interest in Back and Body Medical.

• Empire Plan Physical Therapy Forms – Lower Extremity
• Empire Plan Physical Therapy Forms – Back
• Empire Plan Physical Therapy Forms – Neck
• Empire Plan Physical Therapy Forms – Arm, Shoulder, and Hand
• Empire Plan Chiropractic Care Form – Back
• Empire Plan Chiropractic Care Form – Neck

• Cigna Insurance Physical Therapy Forms – Neck
• Cigna Insurance Physical Therapy Forms – Back
• Cigna Insurance Chiropractic Care Forms – Back
• Cigna Insurance Chiropractic Care Forms – Neck
• Cigna Insurance Physical Therapy Forms – Lower Extremity

• Oxford Plan Physical Therapy Forms – Lower Extremity
• Oxford Plan Physical Therapy Forms – Back
• Oxford Plan Physical Therapy Forms – Neck
• Oxford Plan Physical Therapy Forms – Arm, Shoulder, and Hand
• Oxford Plan Chiropractic Care Forms – Back
• Oxford Plan Chiropractic Care Forms – Neck