If you have any questions or need help filling them out, please bring the forms with you on the day of your appointment.

You may also call (909) 287-7474 to ask what forms you should bring with you - this is only helpful to you, however, if you have already made an appointment for treatment.

You can choose to download all the forms into one PDF file or separate individual forms.

If you do not have Adobe's PDF Reader, you can install it by clicking on the button below.

• Complete CAPI Form Pack (10 pages) - This file contains the complete set of forms you will need prior to your appointment.
• Treatment History (2 pages) - This form asks about your previous medical treatment history.
• Patient Assessment Form (1 page) - This form asks about the nature and locations where you are having pain.
• Personal & Insurance Information Form (1 page) - Use this form to fill out basic information about yourself and your insurance company.
• Medical Records Release Form (1 page) - Use this form to give authorization to have all medical files released to CAPI.
• Pre-Procedure Instructions (1 page) - Read this form to understand what to do and not do before and the day of your procedure.
• CAPI Clinic Contract (3 pages) - This contract must be read and signed before any treatment is provided by CAPI
• Patient Narcotics Contract (1 page) - If you are prescribed narcotic medication, you will need to read and sign this form before any prescription for narcotics are provided to you.