Alliance Health Partners offers our patient form(s) online so they can be completed in the convenience of your own home or office. Please do not complete these forms unless you have been instructed by one of our staff members.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- If instructed, download the necessary form(s), print it out and fill in the required information.
- Email or fax us your printed and completed form(s) or bring it with you to your appointment.
Document Name |
Download |
Description |
Personal Injury (PI) Paperwork |
New patient forms for auto accident/personal injury patients |
|
General Insurance (GI) APS Paperwork |
New patient forms for Medicare or BCBS patients |
|
General Insurance (GI) Paperwork |
Download |
New patient forms for health insurance patients |
Personal Pay (PP) Paperwork |
New patient forms for personal pay/no insurance patients |
|
Workers Compensation (WC) Paperwork |
New patient forms for workers compensation patients |
|
Independent Medical Examination (IME) Paperwork |
New Patient forms for IME referrals |
|
Functional Capacity Evaluation (FCE) Paperwork |
New patient forms for functional capacity referrals |
|
Range of Motion (ROM) Paperwork |
New patient forms for range of motion referrals |
|
Notice of Privacy Practices |
A written notice of all privacy practices used in our office, as required by HIPAA |
