Before your new patient evaluation visit with Dr. Dubrow please fill out the following:  (1) Patient Registration Form; (2) Patient Nutrition Form; and (3) Activities of Daily Living Survey(s) for the issue(s) for which you will be treated by Dr. Dubrow.

The Patient Registration Form AND the Patient Nutrition Form are in PDF format.  You can either complete the forms after printing them out or complete them digitally. Whether you complete the forms after printing them out or complete them digitally, please bring the completed forms with you to your evaluation appointment. If these forms are not completed, your appointment time with Dr. Dubrow will be shorter as time will be spent filling out the forms and Dr. Dubrow may not be able to complete your evaluation at your first visit.

For the Activities of Daily Living survey(s), please use the link(s) below and complete the activities of daily living survey(s) for the body part(s) for which you will be treated by Dr. Dubrow.  The survey(s) will automatically score themselves as you complete them.  Once completed, please print the completed survey(s) and bring the print out(s) with you to your evaluation appointment with Dr. Dubrow.

  1. Knee – http://www.orthopaedicscore.com/scorepages/knee_injury_osteopaedic_outcome_score.html;
  2. Foot and Ankle – http://www.orthopaedicscore.com/scorepages/foot_and_ankle_disability_index_fadi.html;
  3. Shoulder, Arm, Elbow, Hand, and Wrist –http://www.orthopaedicscore.com/scorepages/disabilities_of_arm_shoulder_hand_score_dash.html;
  4. Back (Thoracic Spine, Lumbar Spine and Sacroiliac) – http://www.orthopaedicscore.com/scorepages/oswestry_low_back_pain.html;
  5. Neck (Cervical Spine) – http://www.orthopaedicscore.com/scorepages/vernon_mior_cervical_spine.html ; and
  6. Hip and Leg – http://www.orthopaedicscore.com/scorepages/hip_disability_osteoarthritis_outcome_score_hoos.html.

If you have any questions about your new patient paperwork, please call us at (972) 398-0789.

Below is a map of the location of the clinic:

Location of Clinic

You may need Adobe Acrobat to view and/or edit the documents. You can download it by following this link:

Adobe Acrobat