Office Forms


1. Case History

We now send new patients a history form to complete online. If you did not receive one, please contact our office. Please note that we do not treat Worker’s Compensation injury claims. However, we do treat Motor Vehicle Accidents.

2. Consent to Treatment

Each patient must have an opportunity to both read this form and have an opportunity to discuss it with the chiropractor. You must not sign it until any/all of your questions have been satisfactorily addressed.

3. Other

AB-1 Form

This is the Notice of Loss for motor vehicle accidents. If you have been in a collision, please notify our office prior to your appointment. We may need to schedule more time. Your insurance adjustor will require you to fax this form prior to initiating any treatment process.

Outcome Assessments:

Occasionally, the chiropractor may want to better quantify your pain, and may ask you to fill out one or more of the following forms:

Quadruple Visual Analogue Scale

Pain Disability Questionnaire

Oswestry Index

Neck Disability Index

Headache Disability Index