Forms, Templates, & Doctor Resources

Download and print doctor forms here. If any of the following forms fail to download, reach out and we can send them to you via email.

(PDF Format)

Foot Examination Form

This form is for doctors that have completed the Council on Extremity Adjusting's course on Foot, Gait and Orthotics and will enable CCEP's to correctly examine the foot for making or prescribing foot orthoses.

 
(Microsoft Word format)

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.

 
(PDF Format)

Chiropractic Exam Form

This form is Doctor Hearon’s personal exam form and is perfect for graduates of the CCEP program and doctors trained in extremity adjusting.

 
(PDF Format)

Patient Progress Report

Keep all of your patient notes handy for reference with this patient progress report.

 
(PDF Format)

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)

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.