Patient Forms
Below are your options for submitting the below paperwork to our offices. All new patients must complete this paperwork. Click on the green links open the documents, then print or download them.
Option 1: Print the documents below. Fill them out. Scan them onto your computer or mobile device via a mobile scanning app. Email them to us at info@hodgefamilychiropractic.com
Option 2: Print the documents below. Fill them out. Bring them with you to your appointment and give them to the receptionist when you check in.
Option 3: Receive copies of the the documents from the receptionist upon arrival and fill them out in the waiting room.
FORM 1: PATIENT INTAKE
Fill out this form so that we have your current condition, health history, symptoms, personal information, and insurance information on file.
FORM 2: Financial Policy
We strive to provide the highest quality health care, all the while maintaining affordability for you, the patient. We understand that even with insurance, most patients will experience at least some out of pocket expense. This document will guide you through our policies.
FORM 3: INFORMED CONSENT
Before we can begin treatment, you must consent to the performance of chiropractic adjustments and other chiropractic procedures.