Patient Forms
Give Center for the Functional Restoration of the Spine a phone call at (732) 380-1212

In order for us to best treat your spinal/orthopaedic condition or injury, it is important we have a comprehensive grasp of your current health status. When you come in for your initial visit, please bring all of the applicable items listed below. In the event The Center for the Functional Restoration of the Spine does not have all of your relevant medical records and films at the time of your visit, your appointment may need to be rescheduled.

Information to Bring to the Office

1. Referral(s) and Pre-Authorization(s)

2. Previous X-Rays, MRI or CT Scans: Films and Reports Must Be Provided

3. Medical Records of Previous Testing or Treatment (EMG, Physical Therapy, ect)

4. Any Brace or Support that you are Currently or Recently Used

5. Insurance Card, Photo Identification and applicable Co-Payment

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New Patient Forms

Please download and complete the appropriate New Patient Forms prior to your visit.

New Patient Forms

You can make an appointment request online by visiting our contact page and filling out the form. If you have any questions regarding Workers Compensation or No-Fault forms, please contact our office at (732) 380-1212 or you can send us an email inquiry through the contact page.

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Upon Arrival

Upon arrival at the Center for the Functional Restoration of the Spine, please check in at the front desk, where the completion of all appropriate forms will be verified, and where you will be asked for personal and insurance information. You will also be asked to review and sign a Healthcare Proxy form.

Once registration is complete, you will be escorted to the first available exam room where you will change into a dressing gown. Our staff will review medical history and perform a physical examination. 

A physician will then meet with you for your examination and consultation.

After your examination and consultation, you will receive an explanation of your condition and may be provided with instructions on necessary follow-up diagnostics or appointments. Your physician will discuss the range of treatment options for your diagnosis.

It will take approximately two hours to complete your initial visit and may be longer depending on the complexity of the care required.

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Accessibility: If you are vision-impaired or have some other impairment covered by the Americans with Disabilities Act or a similar law, and you wish to discuss potential accommodations related to using this website, please contact our Accessibility Manager at (732) 380-1212.
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