Get Mcginnis Chiropractic New Patient Questionnaire

The McGinnis Chiropractic New Patient Questionnaire is an essential document that helps healthcare providers understand your health history and current concerns. Filling out the form accurately and completely is vital for receiving the best care tailored to your needs.

Follow the steps to complete the online questionnaire effectively.

1. Begin by pressing the ‘Get Form’ button to access the questionnaire and open it in your preferred editing tool.
2. In the first section, enter your personal information. Fill in your name, nickname (if applicable), address, date of birth, and social security number. Indicate your gender and relationship status by selecting the appropriate options.
3. Next, provide your contact information, including home, cell, and work phone numbers, as well as your email address.
4. Fill out employment details by listing your employer, occupation, and years of experience. Include your business address as well.
5. Designate an emergency contact by providing their name, phone number, and your relationship to them.
6. Indicate how you were referred to the clinic and provide the name of your primary physician, along with permission to contact them if necessary.
7. Move on to the symptoms section. Clearly state your main complaint, how frequently it occurs, whether it is due to an accident or injury, and when it started. Rate your pain on a scale from 0 to 10, where 0 is pain-free and 10 is unbearable.
8. If you have previous experiences with other chiropractors or physicians, indicate them and note your level of satisfaction.
9. In the health history section, circle all applicable medical conditions or treatments. Make sure to include previous surgeries and medications.
10. Provide information about your exercise habits and any supplements you currently take. Note your smoking and drinking habits as well.
11. For those filling out the questionnaire for a minor, complete the consent to treatment section, including the minor’s name and age.
12. Finally, review all entered information for accuracy. Once complete, you can save the document, download, print, or share it as needed.

Complete the McGinnis Chiropractic New Patient Questionnaire online to ensure you receive the best care.