New Patient Paperwork
Capitol Spine & Rehabilitation offers our patient forms online so they can be completed in the convenience of your own home or office.
Is this your First Visit?
Intake & Medical History
If you would like to save time on the first visit, you can complete the forms below.
Involved In an Accident?
Accident Questionnaire
If you were involved in an accident, complete the Accident Questionnaire.
Insurance Accepted
- Auto insurance/ Workers Compensation (Federal and Private)
- Optum Health (Insurance of Veterans)
- Blue Cross/ Blue Shield
- United Healthcare
- Cigna
- Aetna
- Medicare
- ChiroHealth USA
Downloadable PDF Forms
The following forms are PDF files. You will need AdobeReader® to view them. If you do not already have AdobeReader® installed on your computer, Click Here to download.
Can't complete the online forms?
New Patient Paperwork
Download the form, print it out, and fill in the required information. Bring the form to your appointment.
Monday
8:00am - 1:00pm
2:00pm - 6:00pm
Tuesday
8:00am - 12:00pm
2:00pm - 6:00pm
Wednesday
8:00am - 1:00pm
2:00pm - 6:00pm
Thursday
8:00am - 12:00pm
2:00pm - 6:00pm
Friday
8:00am - 12:00pm
1:00pm - 5:00pm
Saturday
9:30am - 12:30pm
Sunday
Closed
Capitol Spine & Rehabilitation
5333 Florida Blvd
Baton Rouge, LA 70806