All of the above forms will need to be completed by all new patients. Please feel free to download these forms, print, and fill them out, prior to your first visit and/or consultation. To view these forms on your computer, please make sure you have the latest version of free Adobe Reader, which you can get here: http://get.adobe.com/reader/
Lauderhill
- OUR MISSION
- CONFIDENTIAL PATIENT INFORMATION
- PATIENT INTAKE FORM
- REQUEST FOR TREATMENT FORM
- CHECKLIST: REVIEW OF SYSTEMS
- MEDICAL RECORD REQUEST
- QUADRUPLE VISUAL ANALOGUE SCALE FORM
- PATIENT PREGNANCY DISCLAIMER FORM
- NOTICE OF PRIVACY PRACTICES – SHORT FORM
- ATTENDING PHYSICIAN’S REPORT
- APPICATION FOR FLORIDA “NO-FAULT” BENEFITS
- ASSIGNMENT OF INSURANCE BENEFITS, RELEASE, & DEMAND
- INSTRUCTION FOR DIRECT PAYMENT TO PROVIDER
- IRREVOCABLE PROVIDER’S LIEN
- PATIENT REQUEST FOR RECORDS
Miramar
- OUR MISSION
- CONFIDENTIAL PATIENT INFORMATION
- PATIENT INTAKE FORM
- CHECKLIST: REVIEW OF SYSTEMS
- MEDICAL RECORD REQUEST
- QUADRUPLE VISUAL ANALOGUE SCALE
- REQUEST FOR TREATMENT
- PATIENT PREGNANCY DISCLAIMER
- NOTICE OF PRIVACY PRACTICES – SHORT FORM
- ATTENDING PHYSICIAN’S REPORT
- APPICATION FOR FLORIDA “NO-FAULT” BENEFITS
- ASSIGNMENT OF INSURANCE BENEFITS, RELEASE, & DEMAND
- INSTRUCTION FOR DIRECT PAYMENT TO PROVIDER
- IRREVOCABLE PROVIDER’S LIEN
- PATIENT REQUEST FOR RECORDS
Chiropractor
Douglas Rapid Rehab has two locations in the South Florida tri-county area, Lauderhill & Miramar, to help you and your health needs. Our world-class diagnostic and treatment facilities have been catering to both injured and non-injured professionals, athletes and everyday people since 1995.
With an aggressive blend in sports injury rehabilitation and traditional chiropractic care, our techniques are unique and effective. Founder Dr. Michael Douglas has extensive experience and credentials, and has performed these techniques on thousands of patients as well as on some of the world’s greatest Olympians such as Usain Bolt, Asafa Powell, Veronica Campbell, Shelly-Ann Fraser and more. Dr. Douglas is the official Chiropractor of the Jamaican Olympic Team since 1996 and is certified in Chiropractic Neurology.
Services
With an aggressive blend in sports injury rehabilitation and traditional chiropractic care, our techniques are unique and effective. Founder Dr. Michael Douglas has extensive experience and credentials, and has performed these techniques on thousands of patients as well as on some of the world’s greatest Olympians such as Usain Bolt, Asafa Powell, Veronica Campbell, Shelly-Ann Fraser and more. Dr. Douglas is the official Chiropractor of the Jamaican Olympic Team since 1996 and is certified in Chiropractic Neurology.