Paradigm Main Page > Paradigm Spine For Patients Patient Forms

Patient Forms

New Patient Package

If you are a new patient, please print each of these forms, complete them as best you can and bring them to your appointment. You may also fax them to (985) 882-4501. Thank you for helping make the most of your visit.

Health History
Health Questionaire

Assignment of Benefits
Assignment of Benefits

Cancellation Policy
Cancellation Policy

Pain Diagram
Pain Diagram

SOAPP-R
SOAPP-R

MedList_tn
PHQ-9

MedList_tn
Patient Medication List

   

Condition Assessment Forms

Depending on the condition being evaluated, the physician may request that you complete one or more of the following questionnaires.  If requested, please complete the appropriate form as best you can and bring it to your appointment to review with the physician. Thank you for helping make the most of your visit.

Depression
Beck Depression Inventory

Oswestry
Oswestry Disability Index

Sleep Epworth
Epworth Sleepiness Scale

Other Useful Forms

Listed below are some of the most frequently requested patient forms. It maybe helpful to review them prior to your visit. These forms do not need to be printed out or brought with you to your appointment.

MedList_tn
Patient Medication List

Refill_tn
Medication Refill Policy

RecordsRelease_tn
Records Release