Essential Office Forms

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Includes…

New Patient Forms:

• Prescription/Letter of Referral
• Courtesy Consultation Certificate
• Telephone Intake Form
• Appointment Info Cover Sheet
• Intake Form
• Appointment & Financial Policy
• Assignment of Benefits
• Anticoagulant Hot List
• Patient Travel Card
• Recommendation Sheet
• Appointment Cards
• Telephone Follow-up Form
• Autonomic Nervous System Information Sheet
• Sign-In-Sheet
• Postural Analysis Sheet
• History of Physical Complaints
• Video Release Form

Questionnaires:

• Accident/Personal Injury
• Activities of Daily Living
• Social History
• Job Description
• Self Help Activities

Headache Forms:

• Headache Questionnaire
• Common Headache Medication Forms
• Headache Diary

Pain Scales:

• Pain Intensity Scale
• Pain Progress Scale

Gift Certificates:

• Therapeutic Message (no time length specified)
• Therapeutic Message (value to be specified)
• 1/2-Hour Therapeutic Message
• 1-Hour Therapeutic Message
• 10 Min. Donated Seated Chair Message
• 1/2-Hour Donated Seated Chair Message
• 1-Hour Donated Seated Chair Message

Letterhead, Statements & Receipts:

• Letterhead
• Statement
• Final Notice Statement
• Receipts
• Invoice for Copies of Medical Records
• Insurance Denial/Deductible Paid to Patient

Checklists & Miscellaneous Forms:

• Health Fair/Seated Chair Checklist
• Seated Chair Massage Registration Form
• Physician Meeting Checklist
• Physician Meeting Log 1
• Physician Meeting Log 2
• Office Information Form
• Fax Cover Sheet

Patient Letters & Cards:

• 7 Different Thank You Cards
• Welcome Cards
• 7 Different Happy Birthdays
• Get Well Letter
• Congratulations Letter
• Sympathy Letter
• 7 Different Holiday Season Cards
• 3 Different Reminder to Schedule Appointment
• 4 Different General Reminders
• 3 Different Missed Appointment Cards
• E-mail Request Form

Physician Letters & Cards:

• Introduction letter to Physicians
• Thank You after Physicians Meeting
• 4 Different Thank You Referrals
• Patient Did Not Schedule
• Patient Did Not Schedule due to Finances
• Unable to Schedule Patient, Numerous attempts made
• Patient Referred by Attorney to Another Provider
• Patient Stopped Therapy Before Completing Prescribed Treatments
• Patient Also Seeing Specialist Continue or Discontinue Therapy by Regions

Sample Reports:

• Initial Report
• Interim Report
• Final Report (A)
• Final Report (B)
• Final Report, Continued Therapy Would be Palliative