Forms
New Patient Paperwork
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This questionnaire is for all new patients or patients who have not been seen in over 3 years who are coming into the office for a consult for Physical Medicine and Rehabilitation/ Pain Management. If you are having a consult with Dr. Michael Wolff, Dr. Jonathan Komar, Dr. Anthony Lee, Dr. Miriam Griggs, Gretchen Post, PA-C, or Ashley Stowers, PA-C, please download this paperwork and bring the completed forms with you to your appointment. This paperwork is available at our front desk; however please plan to arrive at least 30 minutes earlier to ensure sufficient time to complete this comprehensive packet.
*This paperwork is not necessary for follow-up visits, new patients coming for an EMG/NCS only, or for patients coming to see Dr. Breus, our pain and sleep disorders specialist.
New Patient Paperwork for EMG/NCS
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This paperwork includes a brief medical history and signature pages. If you have been referred for an Electromyogram and Nerve Conduction Studies only, and will not be transferring care to one of our physicians, please download this paperwork and bring the completed forms with you to your appointment.
Follow-Up Form
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This questionnaire is required by all physicians (except Dr. Breus) to be completed before each scheduled office visit.* Please fill out each section completely and bring with you to your appointment. This form will also be available at the front desk upon arrival.
*EMG and Diagnostic Ultrasound appointments are not required to complete a follow-up form.
Dr. Breus New Patient Form
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This questionnaire is required by Dr. Breus to be completed before a new patient office visit. Please download this paperwork and bring the completed forms with you to your appointment. This form will also be available at the front desk upon arrival; however, you should plan to arrive 15 minutes earlier to ensure sufficient time to complete the questionnaire.
HIPAA Privacy Practices (read-only)
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This read-only document outlines the notice of privacy practices for protected health information. This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
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