ACCEPTANCE AS PATIENT

I understand and agree that Dr. David DeFries D.C. has the right to refuse to accept me as a patient any time before treatment begins. The taking of a history and the conducting of a physical examination are not considered treatment, but are part of the process of information gathering so that the doctor can determine whether to accept me as a patient.

By clicking next, I agree with the above statement and wish to continue with providing my information.

As you go through the form, some questions will require short answers. If you are using a phone or tablet, you can click the microphone icon and speak your answers or type them using the keyboard.
Questions which allow for multiple answers (how do you describe the pain) will contain squares next to the answers while single answer questions (where does it hurt) will have circles.
Most questions will auto advance to the next after answering while others will require you to hit the arrow at the bottom of the screen. Several questions are required and you will not be able to proceed without answering them. 
There are two sections:

Intake Information: Patient information, present complaints and medical history
Practice policies and HIPPA

Most patients complete these forms in under five minutes. 
These forms must be completed prior to the appointment.

Next will be a series of symptoms. If you currently are experiencing these or have in the past, please select Yes or choose No if they do not apply.

Thank you for taking the time to complete the intake forms online.

To prepare for your visit, please review the following:

1. Please allow +/- 30 minutes from the time your appointment is scheduled to allow for scheduling and travel disruptions. Evey attempt will be made to honor the scheduled time. Dr. DeFries will contact you prior to arriving and if he anticipates a change in the time.
2. An area of about 8x5 feet is needed.  A portable table will be set up that is 5 1/2 feet long by 3 feet wide.  It is best to set the table up next to a sofa or chair.
3. Nearby access to an electrical outlet is preferred.
4. Please secure any aggressive pets. 
5. If you prefer having someone else present, please be sure to have them at the appointment location at the requested time.
6. Please wear loose fitting clothing. Where the pain is is often not where the problem is... the body is one unit and a complete examination requires inspection of many parts. Clothign should allow free movment and allow access to the spine, legs, arms, shoulders and pectoral area. 
7. Physical medicine often requires addressing and contact with areas some deem sensative. Dr. DeFries is keenly aware of this and acts accordingly. Should you, at any time, feel uncomfortable, please alert Dr. DeFries so that particular treatment can be stopped.
8. Be aware that it is common for some treatments to cause tenderness, bruising, redness or soreness. If you experience any unusual symptoms after treatment please contact Dr. DeFries immediately.