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First Visit

Chiropractic Care

Please download the forms, fill them out and bring them in with you at your next visit.

This will reduce your time in the waiting room and get you to your visit quickly.

Click on the form title below to download. Adobe Reader © is required.

If you do not have Adobe Reader, click: "Get Adobe Reader".

IF YOU ARE HAVING DIFFICULTY GETTING THE FORMS,

PLEASE CALL OUR OFFICE


New Patients

all new patients must complete ALL forms below

Child Health History Form
Adult Chiropractic Registration and History
Authorization for Records Release

Financial Policy
Low Back Pain Questionnaire
Neck Pain Questionnaire
HIPAA (Read-Only)
Informed Consent and HIPAA Acknowledgement
Review of Systems

Posture and Ergonomics Evaluation

Credit Card on File Form


Returning Patients

Returning Patient Form

Low Back Pain Questionnaire
Neck Pain Questionnaire

Posture and Ergonomics Evaluation

Credit Card on File Form


Workers Comp and No-Fault

Worker's Compensation Incident Report - Form
Worker's Compensation A9 - Form
No-Fault Assignment of Benefits - Form
No-Fault Incident Report - Form
No-Fault, PI, and Worker's Compensation Patients - Read Only

Medical Lien Form


Nutritional Consulting

We offer nutritional consulting. Please download the form below, fill it out and bring it in with you at your next visit.

This will reduce your time in the waiting room and get you to your visit quickly.

IF YOU ARE HAVING DIFFICULTY GETTING THIS FORM,

PLEASE CALL OUR OFFICE!

Nutritional Consulting Form
Nutritional Symptom Form


Your First Visit

At your first visit the doctor will do a complete physical examination to determine if you are a good candidate for chiropractic care.