Download and print these out to expedite your first visit.
If you're bringing your completed forms to a first visit, please call and let us know, so we can schedule your first visit accordingly.
Additional Forms (based on your current complaint)
NDI Questionnaire - For neck pain
Oswestry Questionnaire - For back pain
Upper Extremity Functional Scale - For arm and shoulder complaints
Lower Extremity Functional Scale - For hip and leg complaints
Fibromyalgia Impact Questionnaire - For fibromyalgia sufferers
Quadruple Visual Analog Scale - For any kind of pain
Headache Disability Index - For all types of headache
And finally, the insurance follow up form. For all Kaiser
referral patients, please print out, fill-in and bring for your FIFTH
visit. After that, you will be told when you need another one
Kaiser Progress Evaluation - Kaiser Permanente Referred patients (not required for Kaiser Choose Healthy patients)