New Patient Forms

New Patient Forms

For A Streamlined First Visit

Rutherford Spine & Wellness Center offers different types of patient form(s) online, so that they can be completed in the convenience of your own home or office.Download the necessary form(s), print it out, and fill in the required information. You can fax us the printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form

This form is required. All cash, major medical and Medicare patients must complete the questionnaire both sides, front and back.

Workmans Compensation Forms

This form is required. All cash, major medical and Medicare patients must complete the questionnaire both sides, front and back.

Personal Injury Forms

Personal injury patients must complete all forms and explain if the injury is due to a motor vehicle or non-motor vehicle incident.

Member Wellness Registration Form

You can fill out this form to register for access to the member wellness section of our website. You are also welcome to sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it to our office. We are happy to make your experience with our clinic and website more connected and advantageous.

Fill Out The Form Below To Schedule Your Consultation