Online Forms

We offer our paperwork on line so you can complete it in the convenience of your own home. Different situations require different forms. so we have categorized them by type.

Third Party Insurance

This let’s us know what’s happened, but perhaps more important, where do you want to take your health?  The Neck Disability and Oswestry Back Disability forms are area specific.  If you have pain in both areas please fill them both out, but if you have problems in only one of the regions, please fill out the appropriate form to that area.

Automobile Accident

If your health issue is the result of a car accident, we need some additional information.

Medicare

If you are a medicare beneficiary, this form lets you know that the initial examination with a chiropractor is not covered by medicare and you will be billed personally for this procedure (even if you have a medicare secondary insurance).  This is a medicare rule, not ours.

Release of Records

Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

Dr. Mark Friedman, 70 New Ocean Street, Swampscott, MA | (781) 581-7300