New Patient Intake Forms


Let's face it! Everyone hates paperwork, however, in this day and age it is a necessary evil. Intake forms like the ones below are used by the doctors at ChiroTrendz to make an accurate diagnosis and develop effective treatment plans. We provide them here so that you can fill them out in the comfort of your home.

 

Adult New Patient 

(Age 12+)

ADULT Intake Form (Age 12+)

Minor Consent Form

Fill out the consent to treat minor form below if you intend to have your minor child examined or treated without you present. 

Consent to Treat Minor without Parent /Gaurdian
 

Pediatric New Patient 

(Birth to age 11)

PEDIATRIC Intake Form (Age Birth to 11)

Sports, School, Scouting Physicals




PHYSICAL Intake Form (Sports, Scouting, etc)
 

Personal Injury

(Motor Vehicle Accident) 

Personal Injury Intake Form -Motor Vehicle Accident
 

Medical Records Release Form



Medical Records Release Form

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