Patient Intake Forms
Would you like to save yourself 20 minutes during your first visit to our office? The following forms are available online for your convenience.
*NEW* Our forms are now "writable" PDF's which means that you can fill them out right on your computer! Simply click on the link(s) that apply to you, once open you will see various areas of the form highlighted in blue. Clicking on these fields will either check the appropriate box or allow you to type in your information. Once complete you can print out the completed forms and bring them with you to your appointment or save them as a file with your first and last name and email it to us! [MAC Users: Fillable fields aren't blue, just click on the various sections and they will transform.]
|GENERAL INTAKE FORMS|
|- Please click on the following link: INITIAL INTAKE FORM|
|The file contains the following forms: demographic and health history questions, pain diagram, chiropractic care consent form, and our appointment cancellation policy.|
|PAIN QUESTIONNAIRE FORMS|
Please fill out ONLY the form or forms that apply to you. The purpose of these outcome assessment tools is to determine YOUR perceived FUNCTIONAL ABILITY prior to starting treatment. They are then utilized again after an initial trial of treatment to determine YOUR perceived functional ability to assess whether the management strategy being employed is making a relevant difference in YOUR ability to conduct and ENJOY LIFE.
When filled out ahead of time, this will save you an additional 5 minutes during your first visit.
|Is your Chief Complaint neck pain? Please click the following link:|
|NECK PAIN QUESTIONNAIRE|
|Is your Chief Complaint back pain? Please click the following link:|
|BACK PAIN QUESTIONNAIRE|
|Is your Chief Complaint headache pain? Please click the following link:|
|HEADACHE DISABILITY QUESTIONNAIRE|
|Experiencing arm, shoulder, or hand pain? Please click the following link:|
|PRENATAL INTAKE FORMS|
|- Please click on the following link: PRENATAL INTAKE FORM|
|The file contains the following forms: same as described above as well as specific questions about your pregnancy.|