Valley Chiropractic Clinic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Health History Form - Required
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
Financial Agreement- Required
Functional Questionnaire: Choose one or More of the following- Required
Low Back Disability questionnaire
Neck Pain Questionnaire
Shoulder Disability Questionnaire
Headache Disability Questionnaire
Informed Consent- Required
PHI Use Disclosure - Required
Accident Report- Required for Auto Accidents
PI Payments- Required for Auto Accidents
Privacy Acknowledgement- Required
Privacy Practices- For your information only
Please contact our office for brochure