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Patient Forms


Preparing for Your First 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 and/or imaging tests

For patients being seen for their neck, please fill out the following forms and return them during your visit:

For patients being seen for their back, please fill out the following forms and return them during your visit:

The more information you can provide, the better prepared your back specialist will be to properly diagnose and treat your chronic back problems. Equally important, especially for your own peace of mind, you should prepare and bring a list of important questions to ask your doctor during this initial visit. Taking notes is also good idea. So don't forget to bring a pen and some paper. You may even want to bring a family member or a friend with you. Your first visit will be a learning experience—for you and your back specialist.

Questions to Ask the Doctor

One of the best ways to ensure your first appointment is a productive one is to prepare a list of pertinent questions prior to your visit. For starters, you may want to simply write down the first questions that come to mind—then share them with a family member. Chances are, you'll both come up with several more important questions to add to the list. Most likely, some of your questions will be answered by your doctor as he reviews your specific condition with you and discusses treatment options. However, any other questions you ask will help the doctor to understand your major areas of concern and how he or she can help you deal with those concerns. Be sure to include anything you feel is important or essential to your understanding of both the problem and the solution. There's no such thing as a dumb question when talking to your doctor—especially about surgery.

Here are a dozen more that you may want to add to your list:

  • Are you able to determine the specific cause or causes of my back pain?
  • What are my non-surgical options, if any?
  • Is surgery likely to help my particular back problem and eliminate my chronic discomfort and/or pain?
  • What is the precise name of the back surgery procedure you recommend?
  • What are the typical risks of the back surgical procedure that you are recommending—and what is the typical success rate for this type of surgery?
  • How large will my incision be and where will it be made?
  • How long will I be in the hospital—before and after the surgery?
  • What will my recovery be like? Will I need physical therapy?
  • How soon will I be able to return to work and/or my normal daily activities?
  • How many surgeries like mine do you perform in a year?
  • Can I talk to one of your patients who has already had similar surgery?
  • If I choose to get a second opinion, could you provide me with a referral?