Chan Chiropractic Clinic, P.S. offers our patient form(s) online so they can be completed it in the convenience of your own home or office. Here are the essential forms we use and why we need them.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print it out and fill in the required information.
• Fax us your printed and completed form(s) or bring it with you to your appointment.

Patient Information Form

This let’s us know what’s happened, but perhaps more important, where do you want to take your health? Download & Print Form

Motor Vehicle Collision Questionnaire

If your health issue is the result of a car accident, we need some additional information. Download & Print Form

Here are some other forms that may be needed and you can review at your convenience;

Pain Diagram Download & Print Form

Neck Disability Index Download & Print Form

Financial Policy Download & Print Form

HIPAA Consent  Download & Print Form

Irrevocable Assignment of Personal Injury Proceeds Download & Print Form

Terms of Acceptance Download & Print Form

Low Back Disability Index  Download & Print Form

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!