Online Forms

Chiropractors, Antigo Wisconsin

View & Print Our Forms Online

1) Download the necessary form(s), print, and fill in the required information.
2) Bring your completed form(s) with you to your appointment.

Patient Health History – Required for New Patients

By completing this form, we’ll have a full picture of your health history and current state of your health. Be sure to also jot down all of your questions and concerns.

Adults & Children 6 years and older: Download & Print Form
Children 5 years and younger: Download & Print Form

Patient Health Information Consent (HIPAA) – Required

This form is required by the federal government to protect your confidential health information. If you would like your spouse, parent, or other important person to have access to information about your health, your appointments, billing, or any other aspect of your care, you’ll need to include them on this form. If you have any questions about this, or any other form, we will be happy to answer them at your appointment.

HIPAA Form: Download & Print

Insurance Benefits Worksheet – Recommended

This form outlines the questions you should ask you insurance company to verify your insurance coverage. It is important to know that it is your responsibility to verify your coverage and understand your financial share of the services provided by our clinic. We strongly recommend that you complete this form and bring it with you to your first appointment.

Insurance Benefits: Download & Print Form

Patient Request for Records – As needed

Use this form when requesting to have your medical records sent to our office from another medical facility.

Request for Records: Download & Print Form

Workers’ Compensation History

If your visit to our office is a result of an injury that occurred while at work, please complete this form. It is required for all Workers’ Compensation claims.

Worker’s Comp Form: Download & Print Form

Auto Accident

If your visit to our office is a result of an auto accident, we may ask you to complete this form.

Auto Accident Form: Download & Print Form