Patient Forms

We highly recommend patients read our clinic Policies. You can save and/or print a copy for your records. Scheduling an appointment with us indicates that you’ve read, understand, and agree to our policies. If you have any questions about our policies or any form, please contact us. If you do NOT agree to our policies, do not schedule an appointment.

New Patients: Our clinic electronic intake forms are sent to you in your initial assessment appointment confirmation email. Please fill out these forms as completely as possible including all signature lines. If a form or section of a form does not pertain to you, such as the Credit Card Authorization form if you do not wish to keep a card on file for visit payments, or Insurance Information section if you do not wish to us to file medical claims on your behalf, leave the form or section completely blank.

Returning Patients: No forms are necessary if your last visit was within the past 12 months and your information and health history has not changed. If your last visit was more than 1 year ago or if any of your information has changed, please let us know and we will send new forms to complete.

If you want Manchester-Bedford Myoskeletal LLC to release any portion of your clinic records to anyone other than your insurance company or if you want us to obtain any medical information from another provider (imaging, diagnosis, records, etc.) for review in this office: Please let us know and we will send you a Medical Records Release Form via our secure portal for you to complete, sign, and submit back to us.  Please understand that no confidential information will be released by us to anyone without this completed form unless another provider sends their own release form with your signature to us.

Click here to view our Notices of Privacy Practices and Patient’s Rights and Responsibilities. You may print copies for your records. Copies are also available from our office upon request. The law does not require us to comply with HIPAA laws or regulations. However, we take our confidential relationship with our patients seriously and endeavor to comply as closely as practicable. No signature is required for this form.