For your chiropractor 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:
- Fill the forms out on your computer, print them and sign them, and bring them to the office at your scheduled appointment time.
- 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.
- Print the forms out, fill them out by hand, and bring them to the office at your scheduled appointment time.
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.
Insured Patients: Insurance Patient Forms
Non-Insured Patients: Self Pay Patient Forms
Medicare Patients: Medicare Patient Forms
Auto Accident Patient Forms: Auto Accident Patient Forms
Extracorporeal Shock Wave Therapy Patients: Shockwave Therapy Patient Forms
Massage Therapy New Patient Forms: New Patient Massage Forms
Massage Therapy Established Patient Forms: Established Patient Massage Forms
Notice of Privacy Practices: Privacy Practices (Page 1), Privacy Practices (Page 2), Privacy Practices (Page 3), Privacy Practices (Page 4)