Patient Intake Forms

Patient rights and responsibilities

Read this form to understand your rights and responsibilities as our patient.

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Financial policy

Download and print this form. Bring the completed form to your first visit.

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HIPAA notice of privacy practices

Please read this document to understand how medical information about you may be used and disclosed.

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Notice of privacy practices receipt

Download and print this form. Bring the completed form to your first visit to acknowledge your understanding of our privacy practices.

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New patient registration

Download and print this form if you are a new patient. Bring the completed form to your first visit.

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New patient history

Download and print this form if you are a new patient. Bring the completed form to your first visit.

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Referral survey

Download and print this form if you are a new patient. Bring the completed form to your first visit.

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Informed Consent for Chiropractic Care

Download and print this form if you are a new patient. Bring the completed form to your first visit.

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