Forms

New Patient Intake Form (Health History) Imagine yourself filling out our brief history form in a luxurious reception area sipping on complementary artesian bottled water and enjoying a snack. If this is your cup of tea, please arrive 10 minutes before your scheduled appointment! If you prefer to do your paperwork in a bathrobe... You can skip the reception area experience and expedite your first visit by pre-filling out this Chiropractic Patient Intake Form. OR If you are coming in for massage only, and have never been a chiropractic patient in our clinic, you will need to fill out this Massage Registration Form instead. Either way, you’re welcome to enjoy our complementary artesian bottled water & snacks. Its up to you! If you have outside records related to your condition (such as x-rays, MRIs, CTs, lab work or reports) please bring them with you. We look forward to meeting you and making this your best chiropractic experience! HIPAA: Woodward Chiropractic Privacy Notice We have always been committed to the privacy of our patients. Federal regulations now require all medical offices to provide full disclosure of office privacy policies. Woodward Chiropractic's HIPAA Notice of Privacy Practices should answer any question you may have in this regards. Additional copies can be obtained from our office on your next visit. The chiropractic and massage intake forms above already include the last page of this document which we need to have signed before your 1st visit. Your signature on that page acknowledges we have made you aware of your rights to privacy and explains the instances where we are allowed or required to release your personal information. Please let us know if you have any additional questions about the privacy practices of Woodward Chiropractic & Massage! Note: Woodward Chiropractic forms require Adobe Acrobat Reader. It is free from Adobe's site (click their icon below).	Did you know: 80% of medical doctors that primarily treat pain think Chiropractic is effective. Links Chiropractic Network

5353 Alpha Road Suite 110A Dallas, TX 75240 - Tel. 972-490-9888 - Fax 972-490-9830 Health information obtained from WoodwardChiro.com is for informational purposes only and is not a substitute for seeking clinical advice or treatment relating to any medical condition. If you have a concern about your health, promptly consult a licensed healthcare provider. ©2009 Dr. Jonathan Woodward


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