New Patient Forms

New Patient Information

We are excited that you have chosen us for your medical care and look forward to meeting you. The New Patient Form is a form that you can fill out and submit online for your convenience. You can also save some time by printing out and completing the other forms in advance of your appointment so we can expedite your visit. If possible, please fax them to 281-947-3229.

1. New Patient Intake Form

2. Notice of Privacy Practices: HIPAA form

3. At least one of the following Pain Indexes. If you are not sure what forms you need please call the office and we will be more than happy to help you or you can wait until you get to the office before filling out the pain indexes. If you have multiple problems please fill out more than one index.

Pain Indexes (OATS)

• Back Pain: This includes upper, middle, lower back pain as well as leg pain beginning in the back and moving into the leg.
  • Back pain Index
  • Back pain Index (Spanish)
• Neck Pain: This includes neck and arm pain that starts in the neck and moves down the arm.
  • Neck Pain Index
  • Neck Pain Index (Spanish)
• Lower body Pain: Includes hip, leg, knee, ankle, or foot.
  • Lower Extremity Functional Scale
  • Lower Extremity Functional Scale (Spanish)
• Upper Body Pain: Includes shoulder, arm, elbow, forearm, wrist, or hand.
  • DASH
  • DASH (Spanish)