Auto Injury Patient Forms

If you were injured in a car accident, you are already dealing with the pain of your injuries. To make your chiropractor visit at OptiLife as simple as possible, please download and fill out these forms in the convenience of your home before your next visit.

Automobile Accident Questionnaire
Copay
Diagnostic Imaging Release
Financial Agreement
Initiation of Treatment
Authorization for Release
Consent Form
Authorization of Benefits and Consent
Disclosure Sheet
HIPAA

 

IMPORTANT!

If you or someone you know has been injured in a car accident, the Florida personal injury guidelines mandate that you receive initial treatment within 14 days of injury. For help filling out these forms or to schedule an appointment, call OptiLife Chiropractic in Tampa at (813) 926-9500 or our St. Petersburg FL location at (727) 698-6088.