The Chiropractic Place offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
Fill out Patient Intake Form
PDF Patient Intake Form
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
There are three forms for new patients to complete:
- Click here to download our standard new patient intake form: New Patient Intake Form
- Click here to download our HIPAA consent form: HIPAA Consent Form
- Click here to download our financial policy: Financial Policy
Please print and bring the completed forms with you to your first appointment; if you do not have a printer, please save and e-mail the completed forms to us at [email protected] prior to your first appointment.
For Medicare-age new patients: Please read our SPECIAL NOTICE FOR MEDICARE PATIENTS prior to your first appointment.
PDF Personal Injury - Auto / Cycle Accident History Form
Have you been involved in a motor vehicle or cycle accident?
If so, please click here to download our auto/cycle accident new patient intake form: PDF Personal Injury-Auto Form