New Patient Forms

Get Adobe ReaderNew patients can save time when they first visit their chiropractor or massage therapist by downloading, printing and filling out our new patient forms. (You’ll need Adobe Reader installed on your computer to open these downloads.)

Chiropractor Forms

New Chiropractic Patient Forms (770KB PDF)
Includes: Confidential Patient Case History, Financial Responsibility Statement, Patient Privacy Notice, Terms of Acceptance, Pain Scale—everything your chiropractor needs to know before treatment.

New Chiropractic Pediatric Patient Forms (754KB PDF)
Includes: Pediatric History, Financial Responsibility Statement, Patient Privacy Notice, Terms of Acceptance, Pain Scale.

Present Health History (165KB PDF)

Personal Injury Questionnaire (94KB PDF)
Patients involved in an automobile accident need to complete this form. Includes: Personal Injury Questionnaire and Insurance Information Questionnaire.

Re-Exam (84KB PDF)
Current patients scheduled for a re-exam need to complete this form. Includes: Present Health History, Oswestry Disability Index, Visual Analogue Scale.

 

Massage Forms

Massage Form for Jennifer Schmidt (282KB PDF)

Massage Form for E. Jade Howard (282KB PDF)

 

© Copyright 2016 Sloan Family Chiropractic
911 5th Ave. E. Suite 202 - 360-956-3900