NEW PATIENT FORMS

​

The below 3 forms are the ones we have a new patient fill out when they first come to our office. To save time, you are welcome to click on the links and print them and then fill them out. You cannot fill out the form online - it needs to be printed and then filled out by hand. It's fine if you would rather wait until you come in for your first visit.

​

1) Print and fill out both pages of the "Chiropractic Registration and History" form: Click on Page1 and Page2.

​

2) Print, sign, and date the "Informed Consent to Chiropractic Care" form: Click here.​

 

​3) Print and sign at the top and bottom of the form, and fill out the names of individuals who you give approval for who, if anyone, we may speak with concerning your health care or your payment for services. You do not have to list anyone if you choose, but you should still sign the top part which acknowledges that you read and understand our office privacy policy. Click here for the form to fill out.

 

4) The policy shown below titled "Notice of Privacy Practices" says basically that our office follows HIPAA guidelines, which means all of our office records and information about you is kept strictly private and is not released unless you give your authorization to do so. This is our office privacy policy which I mentioned above in item 3. There is no need to print or sign this form, but you can download and print it if you would like to have it. We can provide it to you at our office as well. To print, click Page1 and Page2.