New Patient Forms
Chiropractic New Patient Forms
- Registration (patients 12 and older)
- Health history (patients 12 and older)
- Pediatric Registration & Health History (patients 11 and younger)
- Symptom Survey
- Pain Diagram
- HIPAA Privacy policy
- HIPAA Acknowledgement
- Contact Preferences
- Patient Authorization for Release of PHI2 (if requested by Dr. Chris)
Functional Diagnostic Medicine Forms
(The front desk staff will let you know which forms to complete – Basic or Complex)
Basic Paperwork
- Registration (patients 12 and older)
- Health history (patients 12 and older)
- Pediatric Registration & Health History (patients 11 and younger)
- HIPAA Privacy Policy
- HIPAA Acknowledgement
- Contact Preferences
- Metabolic Type
- Symptom Survey
- Toxicity questionnaire
- 3 Day Diet Diary
- Patient Authorization for Release of PHI2
(if requested by Dr. Chris)
Complex paperwork
- Registration (patients 12 and older)
- Health history (patients 12 and older)
- Pediatric Registration & Health History (patients 11 and younger)
- HIPAA Privacy Policy
- HIPAA Acknowledgement
- Contact Preferences
- 3 Day Diet Diary
- FDM Health and Wellness Questionnaire
- Symptom Survey
- Metabolic Type
- Toxicity questionnaire
- Patient Authorization for Release of PHI2
(if requested by Dr. Chris)