Back To Health Wellness Center offers our patient form(s) online so they can be completed in the convenience of your own home or office without a long wait in the clinic.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print it out and fill in the required information.
• Fax us your printed and completed form(s) at 918-259-3002 or bring it with you to your appointment.

Standard New Patient Form

This is the usual required form. It lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Standard New Patient Form

Auto Accident New Patient Form

-Use this instead of Standard Form if you were in an Auto Accident.

This lets us know the history and current state of your health plus any extra information pertaining to an auto accident. We are happy to help you resolve problems arising from those inconvenient crashes.

Download & Print Auto Accident Form

 Outcome Assessment Form

-Use this when a computerized range of motion test is scheduled.

This allows us to calculate your neck, low back, and overall health disability based on researched questionnaires.  We use this mainly for Auto Accidents and for some types of insurance such as ACN/OptumHealth/United Health Care.  Our staff will let you know if you need to fill this out.

Download & Print Outcome Assessment Form

Progress Questionnaire

-Use this when a reevaluation is scheduled.

Download & Print Progress Questionnaire Form

 Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!