atlanticchiropractic.net offers our patient form(s) online so they can be completed in the convenience of your own home or office. Please fill out one of the forms that most applies to you. If you have any questions, feel free to call Atlantic Chiropractic Associates for assistance.
- In order to shorten the length of your initial visit, download the necessary form(s), print it out, fill in the required information, and bring it with you to your appointment. This will help save you valuable time in your busy day!
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
New Patient Intake
Please print and complete the form below. This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
- English - Download & Print form
- Spanish - Download & Print Form
Motor Vehicle Collision Details
Required ONLY if you have been involved in a CAR accident. If you are coming to be treated for an injury sustained in an auto accident, you MUST fill this out.
- English - Download & Print Form
- Spanish - Download & Print Form
Work Injury Details
Required ONLY if you have been involved in a WORK injury/accident. If you are coming in to be treated for an injury sustained while on the job, you MUST fill this out.
- English - Download & Print form
- Spanish - Download & Print Form
Re-Evaluation - New Condition
Please download and complete if you are an ESTABLISHED patient and have not been seen in 90+ DAYS or have new symptoms.
- English - Download & Print form
- Spanish - Download & Print Form
Re-Evaluation - Current Condition
- Re-Eval - Download & Print Form
- Spanish - Download & Print Form
Per federal law and our own office policy, here is a copy our HIPPA Notice of Privacy Practices for you to read and review if you so desire.