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Back to Health Chiropractic Center LLC offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • 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.

New Patient Personal Information Form

Download & Print Form

New Patient Medication, Allergies, and Vaccinations Form

Download & Print Form

Consent to use PHI

Download & Print Form

Office Fees and Erisa/Assignment of Benefits

Download & Print Form

Headache Index

Download & Print Form

Low Back Questionnaire

Download & Print Form

Neck Questionnaire

Download & Print Form

Roland Morris Form ( This form is for pain in the thoracic (mid back) area )

Download & Print Form



Download the Free AdobeReader®

Attention Valued Patients: You may have received a letter stating that we are out of network with Aetna. We have since determined this letter was sent due to an error in Aetna's system and we are not out of network. We are currently working to resolve this issue.
 


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THIS ---->https://backtohealthteamcom.chiromatrixbase.com/online-forms.html

Office Hours

DayMorningAfternoon
Monday8 - 122 - 6
Tuesday8 - 1212 - 4
Wednesday8 - 122 - 5
Thursday8 - 122 - 6
Friday8 - 12Closed
SaturdayClosedClosed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8 - 12 8 - 12 8 - 12 8 - 12 8 - 12 Closed Closed
2 - 6 12 - 4 2 - 5 2 - 6 Closed Closed Closed

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