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Hurst Chiropractic offers our patient form(s) online so you can complete them 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 forms, print them 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 Forms - Required

HIPAA Notice of Privacy Practices

Download & Print Form

Acknowledgement of Receipt of HIPAA Privacy Practices

Download & Print Form

Informed Consent

Download & Print Form

Chiropractic Forms - Required

New Patient Case History

Download & Print Form

Functional Rating Index (Pain and Function Questionnaire - Required)

Download & Print Form

Pediatric Case History (New Patients 12yrs and under)

Download & Print Form

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

Download & Print Form

Optional New Patient Forms

Motor Vehicle Collision Questionnaire (Required for MVC Patients)

Download & Print Form

Spanish Case History

Download & Print Form

Massage Therapy Forms- Required

Massage Therapy Initial Intake

Download & Print Form

Massage Therapy Information and Policies

Download & Print Form

Exclusive Offer

THIS ---->https://hurstclinic.chiromatrixbase.com/online-forms.html

Office Hours

Day Open Closed
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:00am 8:00am 8:00am 8:00am 8:00am Closed Closed
6:00pm 6:00pm 6:00pm 6:00pm 6:00pm Closed Closed

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