Clinician Checklists

Select the clinician checklist or prescription form you need from the list below to download and print a PDF for your convenience.

A Note About Notes

While we will perform and document a complete in-depth comprehensive evaluation of your patient, our notes (while considered as part of the medical record) must also be corroborated by your notes. For example, for a spinal brace we must have a copy of your notes and they need to state the medical need for a spinal orthosis and whether that brace needs to be a custom made device (and why) or can be provided Off-The-Shelf (OTS). The more complete and detailed your notes are, the fewer requests for addendums will be required.

Addendum Requests

These requests may be required as part of your notes to address documentation that needs clarification in order to meet the requirements of the insurance provider. We can help provide recommended edits to you in order to meet these unique requirements.