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Cold Laser Therapy

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Forms

When you schedule your first appointment you will need to complete the following forms. To save time you can download them, print them out and fill them out before coming to your appointment.

The following forms are in PDF format. You will need Adobe Acrobat Reader to read them. You can download Adobe Acrobat Reader free here.

Forms needed for children:

  1. Patient Information
  2. Hippa
  3. Signature on File
  4. Entry History -  Kids

Forms needed for patients recently in an automobile accident:

  1. Patient Information
  2. Hippa
  3. Signature on File
  4. Initial MVC

Forms needed for full health scan:

  1. Patient Information
  2. Hippa
  3. Signature on File
  4. Entry History
  5. Past Health History

Forms needed for pain evaluation:

  1. Patient Information
  2. Hippa
  3. Signature on File
  4. History Short Form

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Chiropractic Lifecenter Inc. Spokane WA - 2110 N. Washington, Suite 1 - Spokane, WA 99205 - 509-327-4373

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