Patient Intake Forms

For your convenience, we can begin the intake process with you online. Please enter all information into the appropriate fields on our intake forms. This information will automatically populate into our computer system. Complete the Patient Intake forms below (PDF) as well as the outcomes survey for the appropriate body part(s). This will save you time in our waiting room and allow us to get to the important stuff, your evaluation and treatment.

Cockeysville New Patients- Click here

White Marsh New Patients – Click here

Remember to also bring your Physician’s Script and/or Referral (if your insurance requires one), any diagnostic imaging reports or previous Physician reports, and your insurance cards.

Patient Intake Packet

Head/Neck/TMJ

Headache Disability Index
Neck Disability Index

Upper Extremity (Shoulder/Elbow/Hand)

Low Back/Pelvis

Lower Extremity (Hip/Knee/Ankle)