Coral Canyon Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.
- Important: Click Here to download AdobeReader® if you don't already have it. Your internet browser will not have all the tools necessary to fill out the forms.
- The forms are interactive/fillable: place your cursor on each line and complete each question.
- Adobe's tools along the top of the document (ie. drawing tool) can be used to mark the body diagram.
- You are welcome to use a digital signature or print it out to sign.
- Fax (435-635-7701) or email (email@example.com) your completed copies, but also bring the forms with you to your appointment.
Patient Information Form This form is for the standard demographic and insurance information.
Patient Complaint Form Tells the doctor where you are hurting and what you want accomplished with your care.
Patient History Form Summarizes past conditions, traumas, surgeries, & medications.
Functional Rating Index A standardized form that objectifies your complaints in the form of a quick survey.
Informed Consent Explains the other accepted forms of treatment for musculoskeletal pain and outlines the minimal risks inherent to any medical procedure.