Additional Forms

Read it before you sign it

Not everyone needs these. We will tell you if one applies to you. You are welcome to read it here first, on your own time. No one is waiting on you.

Trigger point consent form

Consent for trigger point dry needling. It explains what the technique is, what it is used for, and what to expect afterward. So you can decide with the information in front of you.

Dry needling is always optional. Nothing gets done to you here without an explanation first.

Download the trigger point consent form (PDF)

Advance Beneficiary Notice of Noncoverage

This is the standard Medicare form, English version, 2023. It is used when a service may not be covered by Medicare. You know in advance what you may be responsible for, rather than finding out from a bill.

Download the Advance Beneficiary Notice of Noncoverage (PDF)

Questions about either one

Call (319) 382-2743 and ask. We will walk you through what it means in plain language before you fill anything in.

Looking for your intake paperwork instead? That is on the patient forms page.