Cutting Edge Chiropractic Consultants
CECC members may view and download all forms but for this sample page, you may view the Regular New Patient Health History form under section 2 below.
Practice Management Forms Guide Sample
Click here to view the new patient health history form sample.
Table of Contents
- X-ray Report Forms: The following x-ray report forms could be utilized as a guide when reading x-rays.
- Cervical x-ray
- Lumbar x-ray
- Thoracic x-ray
- Shoulder x-ray
- Knee x-ray
- Extremity Study x-ray
- New Patient History Forms/Update Form: The following history forms could be utilized for your initial patient consultation/history.
- Regular New Patient Health History
- Pediatric Health History
- Personal Injury Health History
- Worker's Compensation Health History
- Existing Patient Update Health History: This is for existing patients who have not been seen in 6 months or more
- Headache History
- Patient Exam Forms: The following exam forms could be utilized as a guide for doing a thorough physical exam.
- Lower Quadrant Exam
- Upper Quadrant Exam
- Reception Room Resumes: The following "reception room resumes"(RRR) serve as examples of what we recommend you provide in your reception room. We also have a sample curriculum vitae.
- Dr. Eric Eiselt's RRR
- Dr. Mark King's RRR
- Dr. Steve King's RRR
- Dr. Donna Moloney's RRR
- Dr. Jason Placeway's RRR
- Dr. Mark King's C.V.
- Dr. Steve King's C.V.
- Financial Policy Forms & Insurance Forms: The following forms can be used for insurance/billing purposes.
- Benefits assigned
- Care Source (Managed Medicaid) Financial Policy
- Insurance tracking form
- Insurance financial policy
- Insurance verification form
- Medicaid financial policy
- Medicare financial policy
- Special Consideration/financial hardship form
- Practice Management and Promotion guide forms: The following forms serve as a guide regarding standards of practice management and practice promotion.
- Ethical and Effective Practice Promotion
- Styles of Practice outline/description
- Report of Findings outline/guideline
- Miscellaneous Forms.
- Diagnostic Testing Referral form
- Informed consent
- New Patient Phone Intake form
- Stretches for patients to take
- New Hire Interview Questionaire
- Sample exercise sheets.
- Advanced Plank Series
- Basic Plank Series
- Basic Serratusanterior
- Boat Pose
- Clam 1
- Foam Roller Mobilization
- Hip Extension Swissball
- Intermediate Planks
- Low Back Big 3
- Modified Dead Bug
- One Leg Standing Series
- Posture Relief
- Prone Arm Extensions on Swiss Ball
- Serratus Anterior/Push-up Plus
- Short Foot Exercise
- Ski Jump Exercise
- Triple Loaded Arm Stretch
- Wall Angel Exercise
- Banded Glute Bridge
- Banded Serratus Anterior/Scapular Stabilization Knees
- Banded Serratus Anterior/Scapular Stabilization Prone