Initial Paperwork for EVERYONE (needs to be complete before first visit)
- Initial Health History (for 13 or more years old)
- Initial Health History (pediatric) (for 12 years old or younger)
more Initial Paperwork for EVERYONE (although you do not need to print out)
- Financial Policy Agreement
- HIPPA Privacy Practices
- Informed Consent – Chiropractic
- Records Request – Gives your permission for us to get records from other providers/facilities
Medicare forms
Condition-specific forms
- Metabolic Assessment form (MAF) questionnaire
- Peripheral Neuropathy Intake form
- Fatigue – Adrenal – Thyroid risk (FAT) profile questionnaire
- Headache, Neck Pain, TMJD, Toxicity – Risk Profile questionnaire
- Arthritis & Osteoporosis Risk Profile questionnaire
- Intestinal Dysfunction questionnaire
- Carpal Tunnel Syndrome
- Temperature graph Fatigue – Adrenal – Thyroid
ADHD / Autism / Learning Disorders forms
- Developmental History – Child – if 15 or younger
- Neurobehavioral (Master Hemispheric) Checklist – Child
- ADD-ADHD Type Questionnaire
- ADHD-High-Function-ASD-Fees