Below is a list of forms routinely used in our office, made available for your convenience.

New Patient Paperwork - Download and fill out your new patient paperwork (not required).

Transfer records to Back N Balance - Download, print, and fill out this form and send it to your current NUCCA doctor to have your records and/or X-rays sent to Back N Balance.

Transfer records from Back N Balance - Fill out this form and fax it to us (512-479-6280) to authorize the release of your records from Back N Balance.

Auto Accident Report - Fill out this form if you have been in an auto accident and want to keep record of it on file at our office. Please be sure to bring it in so we can review it and file it for you. You can fill this out in our office as well.

 

 

 

 

Back N Balance
Phone: (512) 479-7878
Fax: (512) 479-6280