Welcome to Hands On Health Chiropractic

New Patient Forms

We offer our new patient forms online so you can download and complete these forms in the convenience of your home prior to your first appointment. Please call us if you have any questions. (817) 421-4775

All New Patients Must Complete These Two Forms Online in Advance of Their Appointment.

New Patient Registration Paperwork (All Patients)

AND

New Patient (Males Only) Consent Forms

OR

New Patient (Females Only) Consent Forms

pdf iconAuto Accident Paperwork (Please print, complete, sign and bring with you to your first visit)

pdf iconDoctor’s Lien (For 3rd Party or Auto Accidents WITH Lawyer – if using your own auto insurance (PIP) you do not need to fill this out)

UHC New Patients ONLY: Please PRINT and fill out these forms IN ADDITION to the online New Patient forms listed above:

pdf iconUHC New Patient Summary Form-Must Complete

pdf iconUHC-Back Index-Must Complete

pdf iconUHC-Neck Index-Must Complete

pdf iconUHC-Keele STarT Back Screening Tool-Must Complete

pdf iconUHC-Lower Extremity Functional Scale (LEFS)-Complete if Applicable

pdf iconUHC-Disabilities of the Arm, Shoulder and Hand-Complete if Applicable

CIGNA New Patients ONLY: Please PRINT and fill out these forms IN ADDITION to the New Patient forms listed above:

pdf iconCIGNA-Patient Progress-Must Complete

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