New Patient Forms2018-08-13T17:52:14+00:00

Patient Forms

We always accept new patient(s). We look to resolve your condition and teach you how to self manage. Are you visiting the Back & Joint Rehab Center for the first time? We look forward to meeting you. We are IN-Network  with PPO plans with Blue Cross Blue Shield of Illinois, Anthem Blue Cross Blue Shield, Aetna, United Healthcare, and Cigna.  For your convenience, and to decrease your wait time, you can fill out the paperwork online through our secured portal system!

Simply schedule your appointment, we will send you an email giving you access to the online patient portal where you can easily and securely fill out the forms using your phone, tablet or computer. The email link is valid for 72 hours for security reasons. So, please login and follow the instructions to create your secured username to access our portal system. If you would like to call to verify your insurance, please have your insurance information ready.

If you would rather complete them using paper, we have included our new patient forms here for you to download and fill out prior to your visit. Please bring them completed to the office on your first appointment. If you have any difficulty downloading them, please let us know and we can offer assistance. If you are being referred to our office, please have the referring doctor information readily available.

Schedule Appointment
Notice of Privacy Practices
New Patient Form
Acknowledgement of Privacy Practices