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NEWS

New Whiplash Information and Videos >
Learn about whiplash and see some fascinating videos.

Back In Touch Newsletter Released >
Find out about Back-2-Back Chiropractics new monthly newsletter.

Accident Checklist Available >
Check out this convenient informational card for your time of need.

Educational Seminars >
Learn about our developing educational series for patients.

Photo Gallery Now Up >
Visit our new photo gallery to tour the office.

Family Friendly >
Bring your children with you. They can play in our childrens play area.


 



Patient Forms

 

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
Link
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

 

 

 

 

 
 
 
 

 

Contact Info

 

Whiplash Info

 

Chiropic

 

 

 

 

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Back-2-Back Chiropractic P.C.