Get Nj Bidwell Chiropractic Center New Patient Intake Form 2011

Completing the NJ Bidwell Chiropractic Center New Patient Intake Form online is essential for new patients to provide accurate information for optimal care. This guide walks you through each section of the form to ensure a smooth and efficient completion process.

Follow the steps to successfully fill out the form.

1. Press the 'Get Form' button to access the intake form and open it in your preferred online editor.
2. Begin by entering your name and the date of completion at the top of the form. This information personalizes your intake and helps the staff keep records organized.
3. Describe the reason for your visit in the provided section. Choose any relevant options regarding how the problem occurred such as auto accident, workman's compensation, or other.
4. In the personal information section, fill in your address, phone numbers, and email. If you prefer not to receive newsletters, mark the checkbox provided.
5. Complete additional personal details including your Social Security number, birth date, marital status, and occupation. If applicable, include your spouse’s name and children’s names and ages.
6. List your emergency contact's name, relationship, and phone number. Provide details for your primary care doctor as well.
7. Indicate how you learned about the chiropractic center and answer any questions regarding your health status, including pregnancy.
8. Specify your chiropractic history by answering the questions about your previous experience with chiropractors.
9. For the chief complaint section, rate your pain level, describe the type of pain, and indicate how often you experience symptoms.
10. Next, explain what activities exacerbate or relieve your pain and share any specific concerns about the problem.
11. Rate your overall health and describe regular exercise habits, including job-related activities.
12. In the family history section, check off any health conditions that may be present in immediate family members.
13. Fill out the medical history section carefully, marking any past or present health conditions and providing a list of current medications, surgeries, and diagnostic tests.
14. If applicable, answer any additional questions about hospitalization and trauma.
15. Conclude by reading any final remarks and signing your name and date to authenticate the form.
16. Finally, save any changes, download the completed form for your records, or print it to bring to your appointment.

Start filling out the NJ Bidwell Chiropractic Center New Patient Intake Form online today to prepare for your visit.