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New Patients

Forms for Your Initial Chiropractic Treatment

New Patients

Save some time at our office and fill out your new patient forms at home.

*Walk-In Patients can pay with cash, checks, credit and some insurance.

**Personal Injury Patients are reimbursed via insurance coverage.

 

*Walk-In Patient Forms

1. Patient Information Page

2. Patient Health History Form

3. Informed Consent to Chiropractic Care

4. HIPPA Notice Page 1

5. HIPPA Notice Page 2

6. HIPPA Notice Receipt

**Personal Injury Patient Forms

1. Patient Information Page

2. Patient Health History Form

3. Informed Consent to Chiropractic Care

4. Accident Information Page 1

5. Accident Information Page 2

6. HIPPA Notice Page 1

7. HIPPA Notice Page 2

8. HIPPA Notice Receipt

9. Notice of Doctor's Lien

10. Authorization and Assignment

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