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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.
HIPAA Notice of Privacy Practices
Acknowledgement of Receipt of HIPAA Privacy Practices
Chiropractic Forms - Required
New Patient Case History
Functional Rating Index (Pain and Function Questionnaire - Required)
Pediatric Case History (New Patients 12yrs and under)
Update Patient 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
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