Patients

Patient Forms:

To save time, we ask that you complete the following forms prior to your first visit.

Patient Intake Form:
This form is to be completed prior to your first visit with Dr. Talerico.


Medical Release Form:
This is for you to fill so we can obtain medical records relating to your Cervical or Lumbar problem.


Cervical (Neck/Arm/Shoulder) Form:
Along with the Patient Intake Form, fill out this form if you are seeing Dr. Talerico for a Cervical (Neck/Arm/Shoulder) related pain or problem.


Lumbar (Low back/Hip/Leg) Form:
Along with the Patient Intake Form, fill out this form if you are seeing Dr. Talerico for a Lumbar (Low back/Hip/Leg) related pain or problem.