New Patient Forms

Below are the latest forms available for new patients visiting HPRC Clinics. These forms can be printed off and completed at your convenience. Please then bring them with you to your first visit. Medicare does require additional paperwork, so if you are covered by Medicare, please select this option below. All other insurers can select the Regular option.

The latest HPRC forms are available below in PDF format. You can download the free Adobe PDF Reader here.

EMG Services

• EMG Medicare Patient
• EMG Regular
• EMG VA

HPRC- Birmingham, AL

• HPRC Birmingham Medicare Patient
• HPRC Birmingham Regular

HPRC – Auburn, AL

• HPRC Opelika Medicare Patient
• HPRC Opelika Regular

HPRC - Lexington and Columbia, SC

• HPRC SC Medicare Patient
• HPRC SC Regular

HPRC at Lanier Hospital – Valley, AL

• Lanier Everyone

Medical and Health Resources – Columbus, GA

• M&HR Everyone

HPRC at St. Francis Hospital – Columbus, GA

• SFH Medicare Patient
• SFH Regular

HPRC Spine Physical Therapy – Columbus, GA

• Spine Center Medicare Patient
• Spine Center Regular

HPRC at The Medical Center – Columbus, GA

• TMC Everyone