Online Forms


 

Today's Chiropractic Clinic offers our patient form(s) online so you can complete 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.

New Patient Health History Form - *Required

 

This let's us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

Terms of Acceptance Form - *Required

Download & Print Form

Payment Types Form - *Required

Download & Print Form

Symptom Survey (optional, but recommended, if you would like a nutritional consult)

Download & Print Form

Pediatric Treatment Form (*Required for Children)

Download & Print Form

Massage Therapy Forms - Insurance, Auto/Work injury

Download & Print Form


Download the Free AdobeReader®

Location
Today's Chiropractic Clinic
614 S 225th Street
Des Moines, WA 98198
Phone: 206-222-8967
Fax: 206-878-7488
Office Hours

Get in touch

206-222-8967