Chiropractic Intake Forms & Patient Questionnaires

A generic medical intake form asks about allergies, current medications, and surgical history. That covers maybe ten percent of what a chiropractor actually needs to know before laying hands on a patient. You need subluxation history, prior spinal imaging, adjustment preferences, and a detailed pain profile that goes well beyond "rate your pain 1 to 10." The patient walking in with a workers' comp claim for whiplash after a rear-end collision is a completely different intake than the one with chronic low-back pain that has been bouncing between orthopedists for three years.

The Chiropractic intake form captures what actually matters in your office. Chief complaint location mapped to spinal region, onset and duration, aggravating and relieving factors, prior chiropractic care with provider names and dates, and a full history of spinal imaging — X-rays, MRIs, CT scans, and when they were taken. It covers the conditions that change how you treat: sciatica, herniated discs, scoliosis, spinal stenosis, degenerative disc disease, and whiplash. It asks about contraindications for adjustments, including osteoporosis, spinal fusion, vascular issues, and pregnancy status.

What Makes This Different from a General Medical Form

Standard health history forms do not ask whether the patient has had prior spinal surgery, what vertebral levels were involved, or whether hardware was placed. They do not capture adjustment preferences — manual diversified versus instrument-assisted, drop table, flexion-distraction, or activator. They do not ask about auto accident involvement, personal injury case status, or workers' compensation claim numbers. If a patient is mid-litigation for an auto accident injury, you need that information before the first adjustment, not three visits in when the attorney calls your office.

The intake form is your internal office document — your staff fills it out during or after the initial visit. The companion patient questionnaire is what you send to the patient ahead of their appointment. It includes health history questions written in plain language, informed consent for chiropractic examination and treatment, HIPAA authorization, and a signature block. The questionnaire asks about medication lists, supplement use, and prior treatment with other providers in a way patients can actually understand and complete without confusion.

Auto Accident and Workers' Comp Cases

PI and workers' comp patients make up a significant portion of many chiropractic practices, and these cases demand more documentation from day one. The form captures accident date, claim number, adjuster contact information, attorney name, and whether a police report was filed. Getting this at intake means your billing staff is not chasing down claim details weeks later, and your notes are defensible if the case goes to deposition or IME review.

Pricing

Each form is $19.99 for the complete set (intake + questionnaire), $14.99 for intake only, or $9.99 for questionnaire only. All PDFs are fillable in Adobe Reader, password-protected against editing, and HIPAA-compliant.