New Patients - NOT auto accident or workers compensation
New Patients - Auto accident or workers compensation claims
Established Patients
Some of our frequently used forms are provided here for your convenience. You will need Adobe Acrobat to view these forms. If you do not have this, click here to be directed to the Adobe website where you can download this free software.
These forms can be printed and completed by hand. Please do this before your first appointment and bring them in with you to save yourself time before your initial visit.
Please also bring your insurance card with you to all appointments. If this is an auto accident or workers compensation claim, please be sure to bring all information provided to you by your insurance company, including the claim number, your representative, and the claim address.
New Patients:
If you are a new patient to Back-2-Back Chiropractic, and coming in for conditions NOT related to an auto accident or work accident, please complete the following forms prior to your first visit.
| Form Name |
|
| Registration Form |
|
| Intake Condition Questionnaire |
|
| Consent to Treat |
|
| Financial Policy |
|
| HIPAA Privacy Policy |
|
If you are a new patient to Back-2-Back Chiropractic, and are coming in for conditions related to an auto accident or workers compensation, please complete the following forms prior to your first visit.
| Form Name |
Link |
| MVA Registration Form |
|
| MVA Intake Condition Questionnaire |
|
| Consent to Treat |
|
| Financial Policy |
|
| Assignment of Benefits |
|
| HIPAA Privacy Policy |
|
Established Patients:
Please use the following forms if you are en established patient with Back-2-Back Chiropractic and are changing your information or are coming in for a new problem.
| Form Name |
Link |
| New Registration Information |
|
| New Condition Questionnaire |
|
|