Patient Forms — Download Before Your Visit
Completing your paperwork in advance saves time at your first appointment and allows our medical team to prepare for your visit. Please download the applicable forms, complete them at home, and bring them with you.
Walk-ins are always welcome — forms can also be completed in our office. If you need assistance with any form, our staff is happy to help you in person or by phone.
Available Forms
New Patient Registration: Basic personal and contact information for new patients.
Medical History: Your health history, current medications, allergies, and prior injuries relevant to your accident care.
Auto Insurance Authorization: Authorizes us to bill your auto insurance carrier directly for your treatment.
HIPAA Privacy Consent: Required acknowledgment of our Notice of Privacy Practices under federal law.
Personal Injury Protection (PIP) Assignment of Benefits: For Oklahoma PIP claims — authorizes your insurer to pay us directly from your PIP coverage.
To request forms in advance or for questions about your visit, call (405) 842-3209. We look forward to seeing you!
What to Bring to Your First Visit
- Photo ID — driver's license or state ID
- Auto insurance card — yours or the at-fault driver's
- Police report or accident exchange form if available
- List of current medications and any known allergies
- Attorney contact information if you are represented
- Prior imaging or medical records related to the injury
Forms You Will Complete at Intake
- New patient medical intake form
- HIPAA privacy acknowledgment
- Insurance and billing authorization
- Accident and injury description
- Medical history and current medications
How to Save Time at Check-In
- Complete paperwork in advance from our Forms page
- Arrive 10 minutes early for intake review
- Bring originals of your ID and insurance card
Frequently Asked Questions About Patient Forms
What forms do I need to fill out for my first visit?
New patients complete a standard medical intake form (accident details, symptoms, medical history, medications), a HIPAA privacy acknowledgment, and an insurance/billing authorization. You can complete these at our front desk or download and complete them in advance.
Can I fill out my paperwork before arriving?
Yes. Downloading and completing intake forms in advance shortens your check-in to about five minutes. Bring the completed forms with you, along with photo ID and your auto insurance card.
Is my information kept private?
Yes. All patient information is protected under HIPAA and shared only with your authorized providers, insurance carrier, and (with your written consent) your personal injury attorney.
What if I don't speak English fluently?
Our clinical staff includes bilingual English/Spanish speakers, and we provide forms in Spanish. For other languages, please let us know when you schedule and we can arrange interpreter support.
Can I sign forms electronically?
Yes. Most intake paperwork can be signed electronically using a tablet at our front desk. If you prefer paper forms, those are also available.
Will I need to sign a Letter of Protection?
Only if your personal injury attorney requests it. A Letter of Protection (LOP) allows us to treat you now with payment deferred until your case settles. Your attorney provides the LOP; we sign it alongside you.
What should I bring in addition to my forms?
Photo ID, your auto insurance card (yours or the at-fault driver's), the police report or accident exchange form if available, attorney contact information if you have one, and a current list of medications and allergies.
How do I request copies of my medical records later?
Call our office at (405) 842-3209 or submit a written records request. Copies are typically available within 5–10 business days and are provided at no charge for your personal use.