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!
Download & Print Form Word Doc
Financial Agreement- Required
Download & Print Form Word Doc
Functional Questionnaire: Choose one or More of the following- Required
Low Back Disability questionnaire
Download and Print Form Word Doc
Neck Pain Questionnaire
Download and Print Form Word Doc
Shoulder Disability Questionnaire
Download and Print Form Word Doc
Headache Disability Questionnaire
Download and Print Form Word Doc
Informed Consent- Required
Download and Print Form Word Doc
PHI Use Disclosure - Required
Download & Print Form Word Doc
Accident Report- Required for Auto Accidents
Download & Print Form Word Doc
PI Payments- Required for Auto Accidents
Download & Print Form Word Doc
Privacy Acknowledgement- Required
Download & Print Form Word Doc
Privacy Practices- For your information only
Please contact our office for brochure