top of page

Forms for Download


Please use the following links to download the appropriate form, print the form, sign the document and fax or email it to Dr. Westerhaus who will contact you.  Please also bring them with you on the day of treatment. 

Adult Patient Forms



  • Please contact us for a fee estimate. 

Pediatric Patient Forms (Age 12 and under)



  • Please contact us for a fee estimate.

Forms to be filled out by a physician:


Optional instructions:

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

bottom of page