Patient Forms

New Patient?

Please download these forms to fill out before you visit us.

You MUST complete all of the pages within the forms including areas which do not pertain exactly to your initial office visit.

Download these forms for new patientDemographics and Assignments of Benefits

Download these forms for new patientExam Patient History

Download these forms for new patientInformed Consent to Treat

The forms below are our Notice of Privacy Practices. You do not need to download these, they are here for your reference.

Download these forms for new patientNotice of Privacy Practices Page 01

Download these forms for new patientNotice of Privacy Practices Page 02

Miscellaneous Forms

Download these forms for new patient36 Question Health Survey

Download these forms for new patientLow Back Disability Questionnaire

Download these forms for new patientNeck Pain Questionnaire

 

About Life Chiropractic