[vc_row full_width=”stretch_row” css=”.vc_custom_1519998951251{padding-top: 40px !important;padding-bottom: 10px !important;background-image: url(http://tucson-old.levoengage.com/wp-content/uploads/2018/02/patient-forms.bg_.jpg?id=5367) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}”][vc_column][vc_column_text]
most commonly used Forms
If you have difficulty downloading any of the forms or you are not able to print the forms, please contact us and we would be happy to mail
or fax a copy of any forms you might need.[/vc_column_text][vc_row_inner equal_height=”yes” gap=”15″ el_class=”pdf-boxes-main”][vc_column_inner el_class=”pdf-box” width=”1/4″][vc_custom_heading text=”Patient Portal” font_container=”tag:h3|font_size:20px|text_align:center|line_height:22px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal”][vc_separator color=”custom” border_width=”3″ el_width=”20″ accent_color=”#457527″][vc_column_text]
Download the App
How to Login to Patient Portal
How to Set Up Your AccountÂ
How to Enter Patient Info on Portal
[/vc_column_text][vc_single_image image=”5378″ img_size=”full” alignment=”center” css=”.vc_custom_1517773677537{margin-bottom: 0px !important;}”][/vc_column_inner][vc_column_inner el_class=”pdf-box” width=”1/4″][vc_custom_heading text=”Medical Records” font_container=”tag:h3|font_size:20px|text_align:center|line_height:22px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal”][vc_separator color=”custom” border_width=”3″ el_width=”20″ accent_color=”#457527″][vc_column_text]
Authorization for Medical Records
Release of Health Information
[/vc_column_text][vc_single_image image=”5378″ img_size=”full” alignment=”center” css=”.vc_custom_1517773677537{margin-bottom: 0px !important;}”][/vc_column_inner][vc_column_inner el_class=”pdf-box” width=”1/4″][vc_custom_heading text=”Physical Therapy” font_container=”tag:h3|font_size:20px|text_align:center|line_height:22px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal”][vc_separator color=”custom” border_width=”3″ el_width=”20″ accent_color=”#457527″][vc_column_text]
New Patient Intake Form
Consent Form
[/vc_column_text][vc_single_image image=”5378″ img_size=”full” alignment=”center” css=”.vc_custom_1517773690239{margin-bottom: 0px !important;}”][/vc_column_inner][vc_column_inner el_class=”pdf-box” width=”1/4″][vc_custom_heading text=”Referring Providers” font_container=”tag:h3|font_size:20px|text_align:center|line_height:22px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal” css=”.vc_custom_1517493440278{margin-bottom: 0px !important;}”][vc_custom_heading text=”(for Referring High School Athletes)” font_container=”tag:h4|font_size:14px|text_align:center|line_height:16px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal” css=”.vc_custom_1517493454260{margin-top: 0px !important;}”][vc_column_text]
Bumps and Bruises Referral Form
[/vc_column_text][vc_single_image image=”5378″ img_size=”full” alignment=”center” css=”.vc_custom_1517797816802{margin-bottom: 0px !important;}”][/vc_column_inner][/vc_row_inner][vc_row_inner equal_height=”yes” gap=”15″ el_class=”pdf-boxes-main”][vc_column_inner el_class=”pdf-box” width=”1/4″][vc_custom_heading text=”FORMS FOR” font_container=”tag:h4|font_size:14px|text_align:center|line_height:16px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal” css=”.vc_custom_1517492856154{margin-top: 0px !important;margin-bottom: 0px !important;}”][vc_custom_heading text=”Dr. Curtin’s Patients” font_container=”tag:h3|font_size:20px|text_align:center|line_height:22px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal”][vc_separator color=”custom” border_width=”3″ el_width=”20″ accent_color=”#457527″][vc_column_text]
[/vc_column_text][vc_single_image image=”5378″ img_size=”full” alignment=”center” css=”.vc_custom_1517773998325{margin-bottom: 0px !important;}”][/vc_column_inner][vc_column_inner el_class=”pdf-box” width=”1/4″][vc_custom_heading text=”FORMS FOR” font_container=”tag:h4|font_size:14px|text_align:center|line_height:16px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal” css=”.vc_custom_1517492856154{margin-top: 0px !important;margin-bottom: 0px !important;}”][vc_custom_heading text=”Dr. Goorman’s Patients” font_container=”tag:h3|font_size:20px|text_align:center|line_height:22px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal”][vc_separator color=”custom” border_width=”3″ el_width=”20″ accent_color=”#457527″][vc_column_text]
Spine – New Patient Paperwork
Spinal Injection/Pain Management
RFA/Cervical/DIscogram[/vc_column_text][vc_single_image image=”5378″ img_size=”full” alignment=”center” css=”.vc_custom_1517774008560{margin-bottom: 0px !important;}”][/vc_column_inner][vc_column_inner el_class=”pdf-box” width=”1/4″][vc_custom_heading text=”FORMS FOR” font_container=”tag:h4|font_size:14px|text_align:center|line_height:16px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal” css=”.vc_custom_1517492856154{margin-top: 0px !important;margin-bottom: 0px !important;}”][vc_custom_heading text=”Dr. Hanks’ Patients” font_container=”tag:h3|font_size:20px|text_align:center|line_height:22px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal”][vc_separator color=”custom” border_width=”3″ el_width=”20″ accent_color=”#457527″][vc_column_text]
Cervical Questionnaire
Back Questionnaire[/vc_column_text][vc_single_image image=”5378″ img_size=”full” alignment=”center” css=”.vc_custom_1517797797975{margin-bottom: 0px !important;}”][/vc_column_inner][vc_column_inner el_class=”pdf-box” width=”1/4″][vc_custom_heading text=”FORMS FOR” font_container=”tag:h4|font_size:14px|text_align:center|line_height:16px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal” css=”.vc_custom_1517492856154{margin-top: 0px !important;margin-bottom: 0px !important;}”][vc_custom_heading text=”Dr. Jeong’s Patients” font_container=”tag:h3|font_size:20px|text_align:center|line_height:22px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal”][vc_separator color=”custom” border_width=”3″ el_width=”20″ accent_color=”#457527″][vc_column_text]
[/vc_column_text][vc_single_image image=”5378″ img_size=”full” alignment=”center” css=”.vc_custom_1517797792267{margin-bottom: 0px !important;}”][/vc_column_inner][/vc_row_inner][vc_row_inner equal_height=”yes” gap=”15″ el_class=”pdf-boxes-main”][vc_column_inner el_class=”pdf-box” width=”1/4″][vc_custom_heading text=”FORMS FOR” font_container=”tag:h4|font_size:14px|text_align:center|line_height:16px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal”][vc_custom_heading text=”Dr. Petrow’s Patients” font_container=”tag:h3|font_size:20px|text_align:center|line_height:22px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal”][vc_separator color=”custom” border_width=”3″ el_width=”20″ accent_color=”#457527″][vc_column_text]
Post Operative Total Knee Instructions
Post Operative Total Hip Instructions
[/vc_column_text][vc_single_image image=”5378″ alignment=”center”][/vc_column_inner][vc_column_inner el_class=”pdf-box” width=”1/4″][vc_custom_heading text=”FORMS FOR” font_container=”tag:h4|font_size:14px|text_align:center|line_height:16px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal” css=”.vc_custom_1517492856154{margin-top: 0px !important;margin-bottom: 0px !important;}”][vc_custom_heading text=”Dr. Landis’ Patients” font_container=”tag:h3|font_size:20px|text_align:center|line_height:22px” google_fonts=”font_family:Source%20Sans%20Pro%3A200%2C200italic%2C300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal”][vc_separator color=”custom” border_width=”3″ el_width=”20″ accent_color=”#457527″][vc_column_text]
[/vc_column_text][vc_single_image image=”5378″ img_size=”full” alignment=”center” css=”.vc_custom_1517797808387{margin-bottom: 0px !important;}”][/vc_column_inner][vc_column_inner el_class=”pdf-box” width=”1/4″][/vc_column_inner][vc_column_inner el_class=”pdf-box” width=”1/4″][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner][vc_column_text]
Please note:Â It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.
[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_single_image image=”5402″ img_size=”full” alignment=”center” onclick=”custom_link” img_link_target=”_blank” link=”https://get.adobe.com/reader/”][vc_btn title=”Request an Appointment” style=”outline-custom” outline_custom_color=”#457326″ outline_custom_hover_background=”#457326″ outline_custom_hover_text=”#ffffff” shape=”square” align=”left” css_animation=”none” link=”url:http%3A%2F%2Ftucson-old.levoengage.com%2Fappointment%2F” css=”.vc_custom_1693346742038{margin-bottom: 0px !important;padding-bottom: 0px !important;}”][/vc_column][/vc_row]