Patient Intake Forms
Welcome to Creech Chiropractic, where you and your family will receive the best care available!
STEP 1:
Prior to your appointment, please select the appropriate link below to complete and submit the new patient forms.
| New Patient Forms | ||
|---|---|---|
| Adult New Patient Form | Complete Online | |
| Pediatric New Patient Form | Complete Online | |
| Personal Injury Patient Form | Complete Online |
The following links are provided for your convenience in filling out your forms:
STEP 2:
Adult New Patient
Adult new patients, please print and complete the below forms as well as the adult new patient form via the link in STEP 1.
1. 
hippa_appointment_reminders_pg_1.pdf
2. hippa_consent_for_disclosure_pg_2.pdf
3. Informed_Consent.pdf
4. Insurance_Disclaimer_9-17-2012.pdf
Pediatric Patient
Pediatric new patients, please print and complete the below forms as well as the pediatric new patient form via the link in STEP 1.
1. Consent To Treat Minor
2. Hippa Appointment Reminders 1
3. Hippa Consent for Disclosure 2
4. Informed Consent
5. Insurance Disclaimer 9-17-2012
Personal Injury
Personal injury patients, please print and complete the below forms as well as the personal injury patient form via the link in STEP 1.
1. Hippa Appointment Reminders 1
2. Hippa Consent for Disclosure 2
3. Informed Consent
4. Insurance Disclaimer 9-17-2012
5. PI Office Policy
6. Lien rev 6-16-2012