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Clients

New Patient Intake Forms

We know how busy life can be. Save time at your appointment by filling out the forms at home! Print and complete, and be sure to mention you have your forms ready when you make your appointment!

Our intake form is required for all new patients. Please fill out the 2 page form as completely as possible, print, and bring to your first appointment.

Personal & Contact Information

Patient Medical History

Credit Card on-file Policy

Informed Consent to Treat

Informed Consent (for minors)

Attendance policy

Dry Needling Consent Form

 

The Health Insurance Portability and Accountability Act is a US law designed to provide privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals and other health care providers. Please bring this sheet signed to your first appointment.

Your Rights as a Patient (HIPAA Explained)

If you require Peak Motion to share your Private Health Information with an outside provider, insurance company or any outside entity, please fill out the Medical Records Release

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