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

• Financial Policy Agreement
• HIPPA Privacy Practices
• Informed Consent – Chiropractic

Medicare forms

• Medicare Payment Guidelines form

Condition-specific forms

• Metabolic Assessment form (MAF) questionnaire
• 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

• ADD-ADHD Type Questionnaire
• ADHD-High-Function-ASD-Fees

Accident & Injury forms

• Auto Accident Questionnaire

Progress Report

• Progress Report