Michiana Wellness & Longevity Clinic
MICHIANA WELLNESS & LONGEVITY CLINIC
Dr. William Lyden
Personal Injury Checklist
Patient Data Questionnaire
Symptom History or Major Complaints
General Pain Disability Index Questionnaire
Neck Disability Index
Oswestry Low Back Pain Disability Questionnaire
Roland-Morris Acute Back Pain Disability Questionnaire
Axillary Temperature Test Thyroid
Medication History
Assignment, Lien, And Authorization For Direct Payments
Clinic Policies Agreement
Financial Policy Agreement
HIPAA
Record Release Form
On Purpose Letter
605 West Edison Road, Suite G Mishawaka, IN 46545-8823
[email protected]
