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
Returning Patients
Workers Comp and No-Fault
Workers' Compensation Incident Report
Assignment of Benefits
No Fault Incident Report
No-Fault, PI, and Worker's Compensation Patients - Read Only
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.
