- We strive to provide complete care for our patients. Learn more about all the services we provide.
Valley Chiropractic Clinic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Health History Form - Required
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
Financial Agreement- Required
Functional Questionnaire: Choose one or More of the following- Required
Low Back Disability questionnaire
Neck Pain Questionnaire
Shoulder Disability Questionnaire
Headache Disability Questionnaire
Informed Consent- Required
PHI Use Disclosure - Required
Accident Report- Required for Auto Accidents
PI Payments- Required for Auto Accidents
Privacy Acknowledgement- Required
Privacy Practices- For your information only
Please contact our office for brochure
Member Wellness Registration Form - Optional
This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!