Our Online Patient Forms

Adams Chiropractic Inc. PS offers you, our new patient, the confidential patient intake forms online so they can be completed in the privacy and convenience of your own home or office. The New Patient Intake Form is electronic-- just fill it out online! This allows your information to be as thorough and detailed as possible so that we can give you the best care available.


Confidential Patient Information Form

We ask that you fill this form out prior to your visit. It includes demographics and patient medical history. Please completely fill out each section that pertains to you. The two documents following the patient intake form are to be reviewed before signing the New Patient Intake Form.

New Patient Intake Form

HIPPA Disclosure - Review

Office Policies - Review


Records Release

Have you visited another facility that took x-rays, adjusted you or diagnosed you with a condition for which you are coming to see us? Please fill out this form and we can request records for our office to review.

Download & Print Form


Testimonial Form

This form allows you the ability to share the benefits and successes that you've had under the care of
Adams Chiropractic. With your permission, we would love to share your successes in your health anonymously in the testimonial section of our website.

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Authorization to Care For a Minor Child - Required

This form can be filled out to authorize treatment for your child if you are unable to attend the first appointment. Please send the form with your child or feel free to fax the completed form to our office at 360-692-4277.

Download & Print Form