New Patient Forms

Patient Forms

New Patient Intake Packet(315.93 KB)

Patient History(78.33 KB)

Patient History Form (PDF)

Patient Data Form (PDF)(76.07 KB)

Patient Data Form (PDF)

Activities Discomfort Scale (PDF)(73.76 KB)

Activities Discomfort Scale (PDF)

Pain Drawing(214.82 KB)

Pain Drawing

Subjective Forms

Activities Discomfort Scale (PDF)(73.76 KB)

Activities Discomfort Scale (PDF)

Pain Drawing(214.82 KB)

Pain Drawing

Exam Forms

Activities Discomfort Scale (PDF)(73.76 KB)

Activities Discomfort Scale (PDF)

Nutrition Forms

Discat Plus: Supplement for the Disc(373.23 KB)

Discat Plus: Nutritional Supplement for the Disc

Formula #2 Supplement for Bones(270.3 KB)

Formula #2 Supplement for Bones

Formula ONE Daily Immune Support(253.75 KB)

Formula ONE Daily Immune Support

Flax Plus Fiber for Bowel Health(124.83 KB)

Flax Plus Fiber for Bowel Health

Disc & Joint Pain Relief Complex(150.09 KB)

Disc & Joint Pain Relief Complex

Exercise Forms

Cervical Spine Hand-Resistance Exercises(151.5 KB)

Cox® Cervical Spine Hand-Resistance Exercises

Cervical Spine Band-Unit Resistance Exercises (682.51 KB)

Cervical Spine Band-Unit Resistance Exercises

Proprioception Exercises(694.19 KB)

Proprioception Exercises with and without a stability ball

10 Basic Low Back Exercises(971.61 KB)

10 Basic Low Back Exercises - no equipment necessary

Low Back Pain Exercises with a Stability Ball (318.33 KB)

Low Back Pain Exercises with a Stability Ball

Uncategorized

Cox Technic Treatment Plan Expectations(156.64 KB)

Cox Technic Treatment Plan Expectations

"This information and website content is not intended to diagnose, guarantee results, or recommend specific treatment or activity. It is designed to educate and inform only. Please consult your physician for a thorough examination leading to a diagnosis and well-planned treatment strategy. See more details on the DISCLAIMER page."