Follow the steps to complete the New Patient Paperwork online.

1. Press the ‘Get Form’ button to obtain the New Patient Paperwork and open it in your preferred editor.
2. Fill in the date at the top of the form to indicate when you are completing the paperwork.
3. Provide your personal details including your full name and date of birth in the designated fields.
4. Enter your residential address, including city, state, and zip code, ensuring accuracy for communication purposes.
5. List your contact numbers under cell, home, and work sections, and ensure the email address is valid for correspondence.
6. Complete the Social Security number section as required for healthcare processing.
7. Indicate your relationship status by selecting one from the available options such as married, single, or other.
8. Specify your occupation and employer information.
9. Provide details about your spouse if applicable, including their name and date of birth.
10. Indicate how you were referred to the practice and provide your primary care physician's name and contact number.
11. Complete the insurance information, including the insurance company name, ID number, group number, and name of the insured.
12. If applicable, answer the questions regarding automobile or work accidents and provide any relevant details.
13. In case of an emergency, provide the contact name, their relationship to you, and their phone number.
14. Clearly describe your primary complaint and any symptoms, including when it started and pain severity on the scale provided.
15. Fill out the review of systems section carefully, marking any applicable symptoms in each category.
16. Complete the past health history and indicate any childhood or adult illnesses, surgeries, injuries, and family health history.
17. Read the assignment and release statement, then provide your signature, indicating consent to treatment and financial responsibility.
18. Sign and date the informed consent section to confirm understanding of the chiropractic process and its implications.
19. If you are a minor, ensure that a parent or guardian signs where indicated, along with their relationship and date of signature.
20. Review your completed form for accuracy, then save changes. You may also choose to download, print, or share the form as needed.

Start filling out your New Patient Paperwork online today for a seamless experience at Graceful Hands Chiropractic & Wellness.