Get Complete Wellness Clinton Il

Filling out the Complete Wellness form is an essential step for receiving comprehensive care at the Clinton Chiropractic Center. This guide will provide clear and detailed instructions to help you successfully complete the form online.

Follow the steps to easily complete the form.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Begin by filling out the 'About You' section. Enter your name, date of birth, address, phone numbers, gender, marital status, social security number, race, language preference, employer information, and emergency contact details.
3. Proceed to the 'Accident Information' section. Detail the date and time of the accident, how the injury occurred, and answer questions relevant to whether an employer was notified in case of a work-related incident and various medical inquiries.
4. In the next subsection, provide additional details regarding your prior treatments for the accident and if you have faced any related health issues in the past.
5. Complete the 'Insurance Information' section. Enter your auto insurance company name, address, adjuster’s information, policy number, and claim number.
6. Describe the accident in your own words by providing a detailed account in the designated area.
7. Identify any symptoms that surfaced following the accident by marking the appropriate boxes in the symptom checklist.
8. Utilize the provided drawings to indicate the areas of pain using the designated codes.
9. Make sure to fill out any additional relevant information, including notes for the doctor if applicable.
10. Finally, sign the form to authorize the necessary medical and financial agreements, ensuring all information is accurate and complete before submission.

Complete your documents online with ease and ensure all necessary details are included.