Online Patient Forms

Alternative Chiropractic & Wellness Center offers our patient forms online so you can complete it in the convenience of your own home or office.

1. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download it for free.
2. Click on the necessary form, print it out and fill in the required information.
3. Fax us your printed and completed forms or bring them with you to your appointment and save time on your visit!

 
Free AdobeReader®  

 New Patient Health History Form - Required

This let’s us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
Download & Print Form

Major Medical Insurance/Cash Patients

1. New Client Health Profile Form
2. Patient Health Information Consent Form
3. Informed Consent
4. Assignment of Benefits
5. Patient Expectations
6. Oswestry Questionnaire

Personal Injury/Accident

1. New Client Health Profile Form
2. Patient Health Information Consent Form
3. Informed Consent
4. Assignment of Benefits
5. Patient Expectations
6. Oswestry Questionnaire
7. MVA Claim Information Form
8. Doctor's Lien

Worker's Compensation

1. New Client Health Profile Form
2. Patient Health Information Consent Form
3. Informed Consent
4. Assignment of Benefits
5. Patient Expectations
6. Oswestry Questionnaire
7. Worker's Compensation Claim Information Form
8. Worker's Compensation Letters of Authorization