Patient Intake Forms

Please download, print and complete these forms before your appointment, or arrive a few minutes early to fill them out in the office. Bringing them completed helps your first visit start on time.

• New Patient Paperwork (All Forms)

  Everything in one PDF: Patient Information & Health History, Functional Rating Index and Informed Consent to Treat.

  Download PDF (4 pages)

• Patient Information & Health History

  About the patient, reason for seeking care, general health history, past history and family history.

  Download PDF (2 pages)

• Functional Rating Index (FRI)

  A short questionnaire on how your condition affects everyday activities such as sleep, travel, work and lifting.

  Download PDF (1 page)

• Informed Consent to Treat

  Consent to chiropractic care, signed by the patient (or a parent or guardian for a minor).

  Download PDF (1 page)

Questions, or trouble with a form? Call (530) 541-5660 and we'll help.