Get Chiropractic Intake Forms

Completing the Chiropractic Intake Forms online is an essential step to ensure your child's health needs are met accurately. This guide will walk you through each section of the form, making the process simple and straightforward.

Follow the steps to fill out the Chiropractic Intake Forms online:

1. Click the ‘Get Form’ button to access the Chiropractic Intake Form and open it in your preferred document editor.
2. Begin by providing your child's full name, ensuring that the last, middle, and first names are entered correctly.
3. Next, enter your child's date of birth in the designated format.
4. In the CURRENT SYMPTOMS section, detail the symptoms that prompted your visit and indicate any relevant common causes such as falls or car accidents.
5. Circle the level of discomfort your child feels, choosing from the provided scale ranging from 0 (no pain) to 10 (worst pain ever).
6. Indicate when the pain started, specifying the hour and how often your child experiences this discomfort.
7. Provide information about any other health care your child has received concerning this issue.
8. In the POSTURE section, report on any consistent postural behaviors your child may exhibit.
9. Outline your child's regular sleeping habits, marking the hours they typically sleep each night.
10. Address the 'Location' section by ticking all areas relevant to your child's pain, along with any symptoms such as allergies or appetite issues.
11. For 'Aggravating/Relieving factors,' describe what exacerbates or alleviates the pain.
12. In the 'Treatment History' section, indicate whether your child has previously received chiropractic care, specifying if they’ve seen another chiropractor or had any recent interventions.
13. Complete the 'Lifestyle' section by discussing your child's activity level, water intake, vitamin consumption, and whether they wear orthotics.
14. Finally, confirm accuracy by signing the form, dating it, and stating your relationship to the patient before submitting electronically.

Take the next step for your child's health by completing the Chiropractic Intake Forms online today.