Hello and thank you for choosing to be a new patient at Ed Camp Chiropractic.
I have posted my new patient documentation here, which will allow you to print and fill out the necessary paperwork prior to our first meeting. The paperwork is very comprehensive but I promise you I will read all of it. The paperwork is very important and increases my capacity to be of help to you.
Thanks in advance, Dr. Camp
PLEASE read these tips designed to help you in filling out the new patient registration forms. The tips are designed to save you some time, as well as not having to do certain pages over when we first meet.
Page 1) the bottom “Consent” is only filled out for treatment of minor children.
Page 4) This is a shopping list of symptoms. Please X all symptoms you currently have even those you think are unrelated to the reason you are in my office. Please circle any symptoms that are common but NOT present as you are filling this sheet out. Such as “I get a headache every week but not today” that would be a circle around headaches.
Page 5) Patient history and the family history below it are the same list. As you review the patient history, if you see anything someone in your immediate family has, check it and write who had it in the space next to the issue they had.
Page 6) Please draw the outside perimeter of any areas that may be painful. These are generally not big circles or rectangles, I am actually looking for the actual shape of the area/s that trouble you. Again please draw in any and all area’s of pain that you may have even include those that may not be main reason you are seeing me.
Pages 7 -10) These are the two Oswestry Questionnaires. There is one for the neck and one for the low back. If you do not have one or the other, feel free to leave it blank. As you read through each section, you will see the answers become more and more severe, please check the first one that sounds like you in each section and don’t read the rest. I am looking for the FIRST appropriate answer.
Page 12) Informed Consent. This is a new version of the form for 2012 and it seems quite effective. The purpose of this sheet is to insure you are aware of, and comfortable with, all the procedures we may do in the office. If you do not understand what any of these procedures are, please ask me to describe them to you when we meet.
There are other situations that patients present needing treatment for such as; auto accidents and other various personal injury cases. There are forms specific to these situations that need to be filled out in addition to the new patient registration. I have placed these options below for your convenience.
Tips to help you fill out the auto accident packet:
Page 2) The box chart of what may have hit what. This is like the things we used to get in school. Draw a line from any body part on the list on the left, to the parts of the car they may have struck on the right. It may be two lines for example: One line between left knee and dashboard, and another between left knee and door panel.
Page 2) On the bottom, there is the list of symptoms you felt IMMEDIATELY after the accident. These could be anything you felt like: Shaken, dizzy, disoriented, pain in one or more places, anything you were aware of right after the accident.
Page 3) Check the boxes that apply with correlation between the symptoms on the left, and time frames moving across the page to the right.
Page 5-6) If there is no Med-Pay you will need to fill out the Medical Lien.
Tips to help you fill out the bicycle accident packet:
Page 2) Check the boxes that apply with correlation between the symptoms on the left, and time frames moving across the page to the right.
Page 3) Only if there is Med-Pay on your insurance. Med-Pay is a feature you may have purchased above your base line coverage that insures your carrier will pay for any treatment you need in a timely fashion and work it out with the responsible parties carrier on the back end of your case.
Page 4-5) If there is no Med-Pay you will need to fill out the Medical Lien.
Tips to help you fill out the pedestrian accident packet:
Page 2) Check the boxes that apply with correlation between the symptoms on the left, and time frames moving across the page to the right.
Page 4-5) If there is no Med-Pay you will need to fill out the Medical Lien.
Tips to help you fill out the slip and fall packet:
Page 2) Check the boxes that apply with correlation between the symptoms on the left, and time frames moving across the page to the right.
Page 4-5) If there is no Med-Pay you will need to fill out the Medical Lien.
I hope you find this information regarding Ed Camp Chiropractic New Patient Documentation helpful. It will streamline our first visit together if you do your paperwork in advance. Thanks for your attention to these details.
