At Krantz Family Chiropractic & Wellness Center, we offer patient forms online so you can complete them in the convenience of your own home or office. Fax us your printed and completed forms or you may bring them during your visit.
New Patient Forms
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!
- New Patient Health History Form
- Chiropractic Patient Policies
- HIPAA Short Forms
- Insurance Notice Non Payable Form
Required Insurance Forms for New Patients:
Complete the Form(s) Related to Your Condition
- Neck Index Form
- Back Index Form
- Functional Index Rating
- Disabilities of the Arm, Shoulder, and Hand Form
- Lower Extremity Functional Scale
- Auto/Work Injury Form
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