New Patient Forms

Northwoods Family Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office before you arrive to our clinic. Allow yourself 15-20 minutes to complete the forms. Please fill out each section completely, selecting "none" if a section doesn't apply to you or "other" if your answer is not listed. When you are finished, please print the forms and bring them with you to your first visit.

Adult

• Assignment of Health Plan Benefits and Rights • Authorization for Release of Medical Information • Informed Consent • Patient Health Questionnaire • Patient Intake Form • Acknowledgement of Receipt of Notice of Privacy Practices • Notice of Patient Privacy Policy

Infants and Toddlers

• Assignment of Health Plan Benefits and Rights • Pediatric Authorization for Release of Medical Information • Informed Consent • Infant Health Questionnaire • Permission To Treat A Minor • Acknowledgement of Receipt of Notice of Privacy Practices • Notice of Patient Privacy Policy

School-aged Child

• Assignment of Health Plan Benefits and Rights • Pediatric Authorization for Release of Medical Information • Informed Consent • School-Age Health Questionnaire • Permission To Treat A Minor • Acknowledgement of Receipt of Notice of Privacy Practices • Notice of Patient Privacy Policy