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Patient Forms

New Patients

For your convenience, we have provided our patient forms on our website. It will take approximately 20-30 minutes to complete these forms. This information is very important to ensure that we can perform a complete and accurate evaluation of your condition and provide you with the best care possible taking into consideration any other conditions you may have. Please fill out all the forms in the “New Patient Intake Forms”. If possible, please fax the first page only of these forms to us at 719-465-2087. This will allow us to complete your registration and accurately verify your insurance prior to your first visit. Please click on the appropriate body part for which we will be seeing you and fill out the form specific to your condition. Bring all of these completed forms with you to your first appointment.








Part of the Body We Are Treating

Pick one below or a dot on
the body to the right
Condition Specific Forms
  • Headache (HDI)
  • Tinnitus / Ringing in Ear (TMD, THI)
  • Temporomandibular / Jaw (TMD, MFIQ)
  • Balance (ABC)
  • Dizziness (DHI)
Returning Patients

Please complete the “Returning Patient Intake Forms” and click on the appropriate body part for which we will be seeing you and complete that form. Bring these forms with you to your appointment. You will not have to complete all of the original intake forms, but we will have you review them and make any changes since you were last seen. Let us know if your insurance, address, or contact information has changed since your last visit.

Current Patients

This weekly home exercise log is provided for your convenience to log exercises you are doing.