Skip to content
Man filling out paperwork

New Patient Forms at
ProAdjuster Chiropractic Clinic

Save time during your first visit

At ProAdjuster Chiropractic Clinic, we offer our paperwork online so you can complete it in the convenience of your own home.

Health History

This let’s us know what’s happened, but perhaps more important, where you want to take your health.

New Patient Intake Form

Neck Pain Disability

Headache Disability

Revised Oswestry Low Mid Back Pain Disability

Release of Records

If you have received chiropractic care elsewhere, or have medical records we will need from another practitioner, please sign this release.

Download & Print Form


HIPAA Acknowledgement of Receipt

HIPPA Notice of Privacy Practices

Automobile Accident

If your health issue is the result of a car accident, we need some additional information.

Download & Print Form

Worker’s Compensation

If your health issue is the effect of an injury at work, this information will help us help you.

Download & Print Form

ProAdjuster Chiropractic Clinic Forms | (920) 261-5784