History Forms

Here are the simple forms that you will be required to fill out when you come in to Chait Chiropractic Center. You can do this in the comfort of your own home or office and be ready when you arrive. There are two forms, each for different situations.

Instructions

 

1) Click in PDF icon
Download the appropriate form to your computer.
2) Open the form Print it out. Please note each form is two pages long.
3) Fill out the form Bring them when you come in for your visit.

 

Patient Forms
Please download and fill out the appropriate form for your situation. Simply click on the appropriate box below.

 

Patient History
pdf iconchico   Download this form if you are a First Time Patient and have NOT been in an accident.

 

Personal Injury Questionnaire
pdf iconchicoDownload this form if you are a First Time Patient and HAVE BEEN involved in an accident.

 

Thank you for your time. We are very glad that you have chosen Chait Chiropractic Center. Our staff will do our very best to make the process as pleasant as possible.

 

To Your Health,
The Chait Chiropractic Team