Patient Forms

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		Formulario en español
Adult New Patient Form	Complete Online	Formulario de nueva paciente adulta
Pediatric New Patient Form	Complete Online	Formulario de nueva paciente pediátrica
Personal Injury Patient Form	Complete Online	Formulario para pacientes con lesiones personales

The following links are provided for your convenience in filling out your forms:

• Language Assistance Service
• Microsoft Reader (Free)
• PDF Reader (Free)

 

STEP 2: 

Adult New Patient
Please review the following forms.
1.    HIPAA_appointment_reminders_pg_1.pdf
2.    HIPAA_consent_for_disclosure_pg_2.pdf
3.    Informed_Consent.pdf
4.    Insurance_Disclaimer_9-17-2012.pdf

 

Pediatric Patient

1.    Consent To Treat Minor
2.    HIPAA Appointment Reminders 1
3.    HIPAA 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.    HIPAA Appointment Reminders 1
2.    HIPAA Consent for Disclosure 2
3.    Informed Consent
4.    Insurance Disclaimer 9-17-2012
5.    PI Office Policy
6.    Lien rev 6-16-2012