A Chiropractic Intake Form is a specialized document used to collect detailed patient information before beginning chiropractic treatment. It includes medical history, lifestyle habits, current symptoms, and consent for care—helping chiropractors create safe, effective treatment plans tailored to each patient’s needs.
Establishes a Baseline for Care
Captures the patient’s current condition, medical history, and areas of concern before the first adjustment.
Supports Safe and Personalized Treatment
Identifies contraindications to spinal manipulation (e.g., osteoporosis, previous surgeries, neurological conditions).
Improves Patient Communication
Clarifies goals, expectations, and lifestyle factors that may affect treatment outcomes.
Ensures Legal and Ethical Compliance
Includes signed consent to treat and acknowledgment of HIPAA and financial policies.
Streamlines Clinical Workflow
Provides organized, standardized information that saves time during evaluations and documentation.
New Patient Evaluations
Completed before the first visit to document health status and musculoskeletal complaints.
Pain Management and Injury Care
Used for patients presenting with back pain, neck pain, joint discomfort, or post-accident recovery.
Wellness and Preventive Care
Gathers lifestyle and postural data for long-term health and spinal maintenance plans.
Worker’s Compensation or Personal Injury Cases
Documents mechanism of injury and symptoms for legal and insurance purposes.
Sports and Active Lifestyle Patients
Captures athletic activities, training routines, and areas of strain to guide care.
Send Digitally Before the Visit
Allow patients to complete the form in advance to improve intake efficiency.
Review Thoroughly During Evaluation
Go over responses to clarify health risks and tailor the care plan.
Use Clear, Non-Technical Language
Ensure patients can understand and accurately complete the form.
Update Annually or As Needed
Reassess and update the form if health status or symptoms change.
Store Securely in the Patient Record
Maintain HIPAA-compliant storage of all completed intake forms.
The leading patient intake platform. HIPAA compliant forms for healthcare providers and organizations. Find out what you're missing!
