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Applegate Clinic of Chiropractic
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New Patient Forms
Bring in your printed and completed forms to expedite your office visit. The following forms and useful documents are in Adobe Acrobat; they require the free Acrobat Reader to view. Click on each to download and view.
 
  Required
Initial Patient Forms (4 pages) - To be filled out by all new patients 10 years of age and older.
Pediatric History Form (2 pages) - To be filled by all new patients newborn to 10 years of age.
   
  Optional
Accident Injury Form (1 page) - To be filled out when seeking treatment for injuries sustained in an auto, work, or personal injury accident.
Living Well for Life Questionnaire (1 page)
 
Your privacy is important to us. All information received in the above forms and through other communications is subject to our Patient Privacy Policy.
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