Patient Paperwork

For Dr. Hough to be able to provide the best and most effective care to you, it is important for us to gain as much information about your health as possible. The following forms should be completed for any patient requiring an examination.

There are three ways to complete this paperwork:

  1. Fill the forms out on your computer, print and sign, and bring them to the office at your scheduled time.
  2. Fill the forms out on the computer and email them back to us at fortwaynechiropractic@gmail.com. We will have you sign them during your visit.
  3. Print the forms out, fill them out by hand, and bring them to the office at the time scheduled.

If these options aren’t accessible to you, you may complete the forms in our office before your appointment. Please arrive at least 15-20 minutes early.

 

Non-Insured Patients: Self Pay Patient Forms

Insured Patients: Insurance Patient Forms

Medicare Patients: Medicare Patient Forms

                                           Auto Accident Patients: Auto Accident Patient Forms

 

Notice of Privacy Practices: Privacy Practices (Page 1), Privacy Practices (Page 2), Privacy Practices (Page 3), Privacy Practices (Page 4)