Chiropractic New Patient Health History Intake Form
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This is a four-page chiropractic intake form (purchased individually or as part of the entire system), takes less than 10-minutes for patients to complete. It takes a thorough history by using check boxes and short fill-ins. Plus, posting your paperwork on your chiropractic website saves time and tends to give you more complete information.
Better Reimbursement Starts on Your Intake
We could have called it “Admitting Paperwork” or “Health History” but with today’s privacy concerns, it made sense to include the word “Confidential.” So we did.
Not only does it collect the history necessary to get paid, it provides a base line to measure subsequent functional improvement resulting from your care. Avoiding denials due to a lack of medical necessity start here. Better reimbursement is around the corner.
Abandon your current intake form immediately!
Consultation Notes on the Intake Form
Not only does it integrate with the other forms in the system, it lays the groundwork for you to justify your services and substantiate your third party claims.
Notice the space along the right edge reserved for making annotations during your consultation. More about this and how to use the other timesaving features are covered in the implementation webinar included with your purchase.
Exactly the History Third Parties Want
Most chiropractors don’t collect the right information or enough of it. Step up to a Paperwork System that reduces requests for additional information—because it’s already there! Upgrade and use the language and supply the information third parties want and expect.
Key Features
Two, double-sided 8½” X 11” or or instruct your printer to make one, double-sided 17” X 11” form
- Personalized with your practice logo and details
- Extensive use of check boxes speeds patient completion
- Space reserved for your consultation annotations—very convenient!
- Includes Activities for Daily Living
- Makes a positive first-impression to you and your practice
- Supplied as a PDF for posting on your website
Order this form individually or the entire Paperwork System, personalized for your practice today. Join our mailing list to receive notification of the latest developments.
With your pre-care history and consultation complete, it’s time for your chiropractic examination.