Back Resort

Patient Intake Form

Welcome to our online Patient Intake Form. The information you fill in will be sent directly to our office, speeding up your office visit and allowing us to better serve your healthcare needs. You will be prompted to share details about one health complaint at a time separately, as well as your general health history, contact and insurance or payment information. You will be directed to customized intake forms if you have had a personal injury (auto accident) or a work injury.

Who are you?