Faldmo Family Chiropractic

"An optimal spine equals optimal health."
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New Patient Center

 

To save you time and to make your visit to our office as convenient as possible we have provided our Intake Forms here.  Please print and completely fill out the New Patient Paperwork by clicking the link.  This link includes the following pages in pdf form:

  • Confidential Patient Information
  • Assignment of Benefits, Release of Information, and Financial Responsibility
  • Stress Test
  • Privacy Authorization 

Please download, print, fill out, and sign each page from the following link:  

New Patient Paperwork.pdf 

Please read:

(You do not need to print the Notice of Privacy Practices, this is for your information only.)

 NOTICE OF PRIVACY PRACTICES.pdf

 If you can not view any of the documents please download the free Adobe Reader from the following site:

 

http://get.adobe.com/reader/