Becoming a new patient at Quality Brain Rehabilitation & Chiropractic Neurology is simple. Call today and schedule an appointment that is convenient for you. Our contact information is listed below, or on the Contact Us page.
To keep things simple we have also included our New Patient Forms as a downloadable PDFs below. Simply click on the download link, download or print off the forms and you can have them already prepared when you arrive for your first appointment.
Quality Chiropractic Welcome Form – Required (The 1st of 4 forms to download)
This lets us know the history and current state of your health & what questions, concerns, goals, regarding wellness that we can help you with. Please be as detailed as you can, as this will help the exam process be more efficient. If you have any questions, the doctor can help answer them when you see him.
Download & Print Form – Welcome Form
Brain Region Localization Form – (The 2nd of 4 forms to download)
We have a Brain Function Form that will assist the doctor on a better overview of your health to get to the root of different problems. He is a Board Certified Chiropractic Neurologist, so he utilizes these extra forms to give him a better picture of how he can help you.
Download & Print Form – Brain Region Localization Form
Neurotransmitter Assessment Form (NTAF) – (The 3rd of 4 forms to download)
We also have a special questionnaire form that too will help assist the doctor in getting you to your optimal health.
Download & Print Form – Neurotransmitter Assessment Form (NTAF)
Metabolic Assessment Form – (The 4th of 4 forms to download)
Download & Print Form – Metabolic Assessment Form
Brain Function Assessment Form (BFAF) – Complete this form if you suffer from Neurocognitive Disorders, Neuroinflammation, Cognitive Decline/Dementia/Alzheimer’s, Traumatic Brain Injuries, Concussion, Post-stroke, Childhood Development Disorders, Neurodevelopmental Disorders, Neuro Developmental Progression, Depression/Anxiety, Chronic Fatigue and Pain, Neuro Development: Windows of opportunity to improve the brain, or Types of Neurodevelopmental Disorders.
Download & Print Form – Brain Function Assessment Form (BFAF)
Peripheral Nerve Localization Form – Complete this form if you suffer from Hand or Wrist Pain, Knee Pain, Low Back, Pelvis or hip Pain, Sciatica, Foot or Ankle Pain.
Download & Print Form – Peripheral Nerve Localization Form
Vestibular Localization Form – Complete this form if you suffer from Neck Pain, Headaches, Vertigo, or Dizziness.
Download & Print Form – Vestibular Localization Form
HIPAA – Notice of Privacy – (This is optional for you to download & print, as it’s for you to keep)
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION – (This is optional & not part of new patient forms)
Download & Print if you need a Medical Release Form