Doctor Forms

Download and print Doctor forms  here.  If any of the following forms fail to download, please send an e-mail request to helpdesk@councilonextremityadjusting.com
 

  • Foot Examination Form
    For doctors that have completed the Council on Extremity Adjusting's (CEA) course on Foot, Gait and Orthotics module. This form will enable CCEP's to correctly examine the foot for making or prescribing foot orthoses.

    (PDF Format, requires Adobe reader)
  • Letter of Medical Necessity
    Send this letter in with your claim forms for orthotics. Be sure to format to accommodate your company's logo and address.

    (MS Word format)
  • Chiropractic Exam Form
    Designed for doctors trained in Extremities Adjusting, this form is perfect for graduates of the CCEP program.

    (PDF Format, requires Adobe reader)
  • Patient Progress Report
    Keep all of your patient notes handy for reference with this patient progress report.

    (PDF Format, requires Adobe reader)
  • Dr. Hearon's Orthotics Examination Station
    A very handy piece of furniture for examining the feet and storing orthotics. This station will enable the skilled CCEP to quickly and efficiently make custom orthotics for their patients on the spot!

    (PDF Format, requires Adobe reader)
  • Knee Flow Chart of Conservative Care
    Avoid repetitive orthopedic testing/challenging of ligaments of the knee during the healing process until near the end of the healing period. Allow the new filaments of the ligaments to reattach with out you disrupting them constantly.

    (PDF Format, requires Adobe reader)

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Disclaimer: All products sold though Hearon Seminars are non-refundable after shipment