Highlands Chiropractic & Wellness Clinic - Patient Forms

Highlands Chiropractic & Wellness Clinic - Make "The Natural Choice" Today for a Healthier Life Tomorrow!

Patient Forms

Instructions: Click on each form, and select open to print

those you need. Print them at home, fill them out, and bring them to your appointment.

New Patient Forms

Welcome Sheet Page 1 Welcome Sheet Page 2

Vehicle Accident Page 1 Vehicle Accident Page 2

Reactivated Patient Forms

Please print and fill out the form to the right if you have not been in the office in more than 3 months.

If you are an ACN, United Healthcare, United Healthcare of the River Valley, Secure Horizons, or Medicare Complete Secure Horizons member, please complete the following Patient Notification Form, Back Index Form, and Neck Index Form if requested by your insurance carrier. The forms can be downloaded by clicking on the links below.

What's New

https://www.myoptumhealthphysicalhealth.com/Documents/Forms/PSF750.pdf

https://www.myoptumhealthphysicalhealth.com/documents/forms/BackIndex.pdf

https://www.myoptumhealthphysicalhealth.com/documents/forms/NeckIndex.pdf

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