- We strive to provide complete care for our patients. Learn more about all the services we provide.
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Hurst Chiropractic offers our patient form(s) online so you can complete it in the convenience of your own home or office.
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!
-HIPAA Notice of Privacy Practices
-Acknowledgement of Receipt of HIPAA Privacy Practices
-New Patient Case History
-Functional Rating Index (Required Pain and Function Questionnaire)
-Pediatric Case History (New Patients 12yrs and under)
-Authorization to Treat a Minor (Required for Patients under 18yrs.)
-Update Patient Case History (Required after 3+ years lapse in care)
-Pediatric Update Case History (Required after 3+ years lapse in care)
Optional New Patient Forms
-Motor Vehicle Collision Questionnaire (Required for MVC Patients)
-Spanish Case History
Massage Therapy Forms- Required
-Massage Therapy Initial Intake
-Massage Therapy Information and Policies
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!
Hurst Chiropractic has such an awesome staff! They have always been so good to me! Dr. Chad has been so helpful with the adjustments and even explaining stretches to help. Went there all through my pregnancy to help with my back pain and now I am taking my son there as well. They do great with children! Highly recommended!