Patient Forms

Preparing for Your First Inspired Spine Visit

A little preparation before your first appointment can be highly beneficial for everyone concerned. It starts by making sure you have all of the information you’ll need to accurately complete a comprehensive new patient medical form. Be prepared to provide personal information that includes:

• Your general medical history
• Your surgical/hospitalization history
• Your family’s medical history (father, mother, siblings, etc.)
• Your allergies
• Your childhood illnesses
• All of the prescriptions, over-the-counter medicines, and supplements you take
• Recent inoculations
• Any recent changes in your health
• Recent X-rays, MRIs and/or CT scans

For your convenience, you can download and fill out these forms prior to your visit with Inspired Spine

All New Patients

• New Patient Registration
• Medical Release Form
• Medical Information Authorization
• CT Patient Questionnaire
• Comorbidity Index Screening
• Notices of Privacy Practices
• Patient Financial and Billing Consent
• Patient Privacy Consent
• Patient Expectation Management

Neck Pain Patients

• Neck Pain Questionnaire

Back Pain Patients

• Low Back Pain Questionnaire

Surgery Patients

• Patient Expectation Management
• Post-Operative Restrictions Form
• Patient Information and Log Book

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Questions?

Call Inspired Spine today at (952) 225-5266 to speak with one of our Patient Care Coordinators about our conservative treatment path.