Hurst Chiropractic offers our patient form(s) online so you can complete it in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print it out and fill in the required information.
• Fax us your printed and completed form(s) at 509-884-2363 or bring it with you to your appointment.
• You can e-mail the completed form to frontdesk@hurstclinic.com .

New Patient Health History Forms - Required

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!

-New Patient Case History

Download & Print Form  

-Functional Rating Index (Required Pain and Function Questionnaire)

Download & Print Form

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-Pediatric Case History (New Patients 12yrs and under)

Download & Print Form

-Authorization to Treat a Minor (Required for Patients under 18yrs.)

Download & Print Form

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-Update Patient Case History (Required after 3+ years lapse in care)

Download & Print Form

-Pediatric Update Case History (Required after 3+ years lapse in care)

Download & Print Form

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Optional New Patient Forms

-Motor Vehicle Collision Questionnaire (Required for MVC Patients)

Download & Print Form

-Neck Pain Questionnaire - English

Download & Print Form

-Neck Pain Questionnaire - Spanish

Download & Print Form

-Low Back Pain Questionnaire - English

 Download & Print Form

-Low Back Pain Questionnaire - Spanish 

Download & Print Form

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Massage Therapy Forms- Required

  -Massage Therapy Initial Intake

Download & Print Form

-Massage Therapy Information and Policies

Download & Print Form 

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 Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!