Patient Information Forms


A complete medical history is necessary to allow your Initial Point provider to assess your needs, make diagnoses and provide treatment recommendations. Please fully complete the forms forms and verify accuracy of the information.

This will help your provider to better know your personal medical history, individual needs, medications and allergies.

Click the links below to open the forms using Adobe Acrobat. Print and complete the forms, and bring them with you when you come in for your appointment. (Please don’t email this information.)

New Patient Forms:
Automatic Withdrawal Form:

There may be additional forms to complete when you have scheduled an appointment. You may need to come early for your appointment to complete them. Please bring your ID and any insurance information to each appointment (medical, workman’s compensation or from a motor vehicle accident).

In addition, please bring a list of your medications and the current dosages. If you do not bring this information or are late for your appointment, we reserve the right to reschedule your appointment.  We appreciate your care in completing this advance preparation for your appointment.

Medical Records Forms: