You are using an outdated browser. Please upgrade your browser to improve your experience.
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
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!
What can we help you find?