Online Forms

McLaughlin Chiropractic Center offers our patient form(s) online so they can be completed it in the convenience of your own home or 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.

SECTION I

Required for All Patients:

Application for Treatment

Authorization for Appointment Reminders and Healthcare

Authorization, Records Release and Assignment of Benefits

Quadruple Visual Analogue Scale

Low Back Pain and Disability Questionnaire

Neck Disability Index

SECTION II

For Personal Injury Patients:

Application for Treatment

New Patient Health History

Personal Injury Questionnaire

Assignment of Benefits

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SECTION III

For Reactivation:

For Patients who have not been treated in our office in the past 6 months and wish to re-activate their file, please complete the following:

Low Back Questionnaire (if pain is in low back area)

Neck Questionnaire (if pain is in neck area)

Quadruple Visual Analogue Scale 

 _______________________________________________________________________

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website.  You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online or you can use our default user name and password. The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form

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