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Element Wellness Center
New Patients

Patient Forms

Save time at your appointment by downloading and completing your patient forms before your visit. Print the forms, fill them out, and bring them with you.

Complete Online

Patient Intake Forms

Complete your intake forms online for Red Light Therapy, Spinal Decompression, Chiropractic Adjustments, and The Joint Lab services.

Downloadable Forms

Available Forms

Click the download button to save each form to your device

New Patient Intake Form

Required for all new patients. Includes medical history, contact information, and insurance details.

Download

Health History Questionnaire

Detailed health history including past conditions, surgeries, medications, and family medical history.

Download

HIPAA Privacy Authorization

Required authorization form for the use and disclosure of your protected health information.

Download

Informed Consent for Treatment

Consent form acknowledging the risks and benefits of chiropractic care and treatment procedures.

Download

Financial Policy & Agreement

Overview of our payment policies, insurance billing procedures, and patient financial responsibilities.

Download

Auto Accident Intake Form

Additional form required for patients seeking treatment following an automobile accident.

Download

Work Injury Intake Form

Additional form required for patients with work-related injuries or workers' compensation claims.

Download

Need Assistance?

If you have trouble downloading or printing any forms, please contact our office and we will be happy to mail them to you or have them ready when you arrive for your appointment.

Cancellation Policy

Please understand that we have a waiting list for our practice. If you must cancel or reschedule your appointment, we respectfully request 24 hours notice. Missed appointments, or appointments cancelled within 24 hours notice, will be charged a cancellation fee.

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Ready to Schedule Your Visit?

Once you've downloaded and completed your forms, give us a call or book online to schedule your appointment.

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