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New Patient Forms

New Patients

Please print and fill out the necessary new patient forms below:

• New Patient Intake Form – download here

• Quadruple Visual Analogue Scale – download here

• Activities of Daily Living – download here

• Health Background – download here

 

IN ADDITION TO THE ABOVE FORMS:

 

Please Fill out the following forms if you have:

• Back Pain – download here

• Neck Pain – download here

• Disabilities of the Arm, Shoulder, and Hand – download here

• Lower Extremity – download here

 

Existing Patients

Please fill out the forms below:

• Progress Evaluation – download here

• Quadruple Visual Analogue Scale – download here

 

Please Fill out the following forms if you have:

• Back Pain – download here

• Neck Pain – download here

• Disabilities of the Arm, Shoulder, and Hand – download here

• Lower Extremity – download here

 

Pediatric Patients – Please fill out the forms below:

• Consent to Treat a Minor – download here

• Patient Intake Form – download here

• Pediatric History – download here

 

Motor Vehicle Patients – Please fill out the forms below:

• New Patient Intake Form – download here

• Motor Vehicle Patient – download here

• Quadruple Visual Analogue Scale – download here

• Activities of Daily Living – download here

• Health Background – download here

 

Please Fill out the following forms if you have:

• Back Pain – download here

• Neck Pain – download here

• Disabilities of the Arm, Shoulder, and Hand – download here

• Lower Extremity – download here

 

“I have been a patient at Life Line Chiropractic for over 2 year for severe lower back pain. My experience has been an extremely positive one. The level of care provided by Dr. Tammy and her staff has been excellent… I continuously recommend Chiropractic Care to anyone who complains of back pain and joint pain. And not just any chiropractor… I will always be grateful to Dr. Tammy and her staff for improving the quality of my life!” – Rose
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