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Chiropractic Intake Form Template

Easily send and receive your chiropractic intake forms online. Send patients your online intake form to fill out on their phone, tablet, or computer. Patients securely sign and submit completed chiropractic intake forms directly to your account online. Track the progress of new patient intake forms, send automated reminders, and receive completed forms online.
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Chiropractic Intake Form

Chiropractic Intake Form Template

Give clients the freedom to complete chiropractic intake forms with any device, anywhere. Streamline the way you collect signatures and consent forms by setting up your chiropractic intake form online. 

Easily personalize this chiropractic intake form template with a HIPAA compliant form builder.

Streamline patient forms and engagement

Collect forms. Engage patients. Automate follow-up.

What is included in the Chiropractic Intake Form Template?

01Patient Information

Your chiropractic intake form will require the patient’s information, which will include; the patient’s name, phone number, address, email address, date of birth, social security number, and other identifiable information that is relevant. 

02History

Health history will collect important information and give you all you’ll need to correctly assess your patients based on their personal health history, as well as the history of any family members. 

03Privacy Practices and Consent Forms

This Chiropractic Intake Form Template packet has included a notice of privacy practices as well as an informed consent form. Cover all of your bases in one simple location!

04Questionnaire

This chiropractic intake form template includes both a neck pain disability questionnaire as well as a back pain disability questionnaire. These forms will gather the important information to help you assess each of your patients quickly and efficiently.

05Required Form Fields

Always get the information you need with required fields. Patients can only submit when they complete all of your required fields. Never receive an incomplete medical form again.

06Drawing And Diagrams

Allow your patients to draw on an image or diagram in your form to mark areas of pain or parts of the body that may need treatment.

07File Attachment Upload

With file upload fields, your patients can upload their prescriptions, x-rays, medical records, insurance card photos and more with their form submission.

Discover More Form Features

Setup HIPAA compliant online forms. Streamline your process of collecting information from patients.
Autocomplete populating patient information across multiple forms

Autocomplete Forms

Have your patient enter information once and have it autocomplete throughout your medical form online. Automatically populate PHI directly into additional fields and medical consent forms.

Required form fields preventing submission of an incomplete patient form

Required Form Fields

Always get the information you need with required fields. Patients can only submit when they complete all of your required fields. Never receive an incomplete medical form again.

Multiple patient forms combined into a single online intake packet

Intake Form Packets

Combine multiple pages into an online form packet. Have your patients fill out their medical history, consent to treat, and demographics all in one new patient intake form packet.

HIPAA Compliant Electronic Signatures

HIPAA Compliant Electronic Signatures

Collect electronic patient signatures before the appointment. Easily give your patients the ability to digitally sign from their phone, tablet, or computer.

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They love FormDr - and so do their patients

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    Woodlands Dermatology
    Angela H.
  • “

    Patients can fill out the forms at their leisure, and don’t have to print anything. We’re collecting more completed forms than ever, and patients love not having to do anything when they come to the office for the first time.

    FYZICAL MetroWest
    Lauren A.
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    FormDr allows me to send and receive attractive, professional forms from patients. Very helpful that I can remind patients of their appointment time and check the status of the form.

    Banks Hepatology Institute PC
    Alpha B.
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    Sending a PDF was too time consuming for the patients to do, and it required the additional steps of printing and scanning it into our own systems. FormDr made it easier to get patients to complete the forms by email, and it’s a more secure way to provide info than simply emailing back a completed PDF.

    Reload Therapy
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  • “

    Before FormDr, the most common struggle were our patients taking a long time to complete forms in our office. Now patients are able to be seen faster when forms are completed prior to visit. Very easy service to create forms online!

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    The support is second to none. FormDr has been instrumental in streamlining our intake of new patients.

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    Before, clients weren’t signing our forms before the appointment. FormDr has allowed us to share our documents for client review and signatures. I really appreciate the support, it has been super helpful simplifying our forms!

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FormDoctor gives your practice one HIPAA-compliant platform to collect forms, communicate with patients, and automate follow-up. We help practices who:

  • Are still using paper forms, PDFs, or Word documents
  • Spend too much time printing, scanning, emailing, and calling patients
  • Need an easier way to send reminders and automate follow-ups
  • Want to streamline forms, communication, and paper workflows