Thank you for contacting our office to help you in your healthcare.
This web page contains the forms we will need to establish a file for you. By printing and completing the appropriate forms before your first visit, will allow for you to do so in the comfort of your own home, and usually results in more accurate and complete information that we are requesting from you.
Personal Insurance & Self-Pay Patients:
If you are coming to our office with general health concerns, and plan to use your personal insurance or pay on your own for each visit, please use the forms under "Adult Intake Form" or "Child Intake Form". The Child Intake Form should be used for any individual who is under 18 years old and is considered a "minor" under the law.
Motor Vehicle Accident Patients:
If you are coming because of an injury such as an auto accident and anticipate someone else's insurance company to cover your care, we need you to complete the forms under "Adult Auto Injury Intake Form" or "Child Auto Injury Intake Form". Again, the Child Intake Form should be used for any individual who is under 18 years old and is considered a "minor" under the law.
Please bring with you a copy of the incident report, a copy of your insurance policy declaration page (or "Dec Sheet"), and the information regarding the other driver(s) and their insurance policy number(s) and contact information. Bringing this information in will allow us to verify coverage and grant care under a medical lien and postpone payment until the case is settled.
All Patients: The more complete the information you give to the doctor, the more efficient we can help you in your healthcare. Please review the file below labeled "Comparative Pain Scale". When completing the portion about your level of pain, this scale or pain level description will help us make this very subjective review of your pain levels more objective, especially as we review your progress during care. I do not recomend printing out this page as it will require a great deal of ink and you can just refer to this page online when ever you need.
Printing or saving the file labeled "Patient Privacy & Rights Notice", is optional and is here for your reference.
Dr. Atkinson has tried to make these forms easy to complete yet provide us with the necessary information to best help each patient. If you have any questions do not hesitate to contact our office and we will do what we can to answer any questions you may have.
Lastly, the fees payable for the day will be dependent on your co-pays, co-insurance, and or deductibles.
We look forward to meeting you and helping you in your healthcare.
Adult Intake Form
Child Intake Form
Auto Injury Intake Form
Patient Privacy & Rights Notice
Comparative Pain Scale
Download the Free AdobeReader®