Filling this in before you come means your first appointment starts with your history and examination instead of a clipboard. Two things worth knowing before you begin: it is one continuous form rather than steps you can save and return to, so set aside enough time to finish in one sitting; and it includes a diagram where you mark where it hurts, which is far easier on a phone or tablet than with a mouse.
Have these to hand
- Your insurance card The form asks for the company, policy number, group number and the insurer’s address and phone.
- Social Security number Yours, and the policy holder’s as well if the plan is not in your own name.
- Medications and supplements A list of what you currently take, including vitamins.
- An emergency contact Their name, relationship to you and a phone number.
- Previous chiropractic care The name of the chiropractor and roughly when you last went, if you have been before.
- Accident or work details If your visit relates to a job or an accident, when it happened and whether you reported it.
The form asks for a Social Security number so we can bill your insurer. How we handle what you send us is covered in our privacy policy. If you would rather not enter it online, leave it blank and bring the card with you.