Here at Valley Chiropractic, we value our patients. We acknowledge that going to a new place for the first time can be nerve racking. We want to do everything we can to eliminate any unnecessary stressors, which is why we include the option of printing and completing your forms at home. We think of our patients as part of our extended family, and we are excited to meet you!

If you have any questions regarding your first visit, please don’t hesitate to call us at (818) 998-1527.

New Patient Forms – Required

These let us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know! All of the following forms are required for new patients.

  1. Welcome – Download & Print
  2. Intake Form – Download & Print
  3. Informed Consent Form – Download & Print
  4. Assignment of Benefits – Download & Print
  5. Financial Policy Agreement – Download & Print
  6. HIPPA Policies – Download & Print (information only, nothing to fill out)

We encourage all our new patients to watch this short 3 min video prior to their first visit.

 

The Beginner’s Guide


Automobile Accidents and Worker’s Compensation

These forms only need to be filled out if you have been in a car accident or had an injury at work.

  1. Auto Accident Questionnaire – Download & Print Form
  2. Workman’s Comp Intake – Download & Print Form

Welcome Back Form

If we haven’t seen you for more than 6 Months – Download & Print