Performance Health Medical Group offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print it out and fill in the required information.
• Fax us your printed and completed form(s) or bring it with you to your appointment.

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New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

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ACCIDENT HISTORY QUESTIONNAIRE

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

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Back Pain OSWESTRY DISABILITY INDEX 2.0

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

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Confidential Patient Information

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

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DOCTOR'S FIRST REPORT
OF OCCUPATIONAL INJURY OR ILLNESS

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

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Federal First Report of Injury

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

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HEADACHE DISABILITY INDEX

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

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The Neck Disability Index

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

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PAIN DISABILITY QUESTIONNAIRE

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

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PRIMARY TREATING PHYSICIAN’S PROGRESS REPORT (PR-2)

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

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QUADRUPLE VISUAL ANALOGUE SCALE

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

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Treatment Authorization

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

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Website Member Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also 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 in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form

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Thank You For Visiting
Performance Health Medical Group
Call us today at 949-362-8877!