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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.

  • 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!

-HIPAA Notice of Privacy Practices

Download & Print Form

-Acknowledgement of Receipt of HIPAA Privacy Practices

Download & Print Form

-Informed Consent

Download & Print Form

-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

-Spanish Case History

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!

Download & Print Form



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

Office Hours

DayOpenClosed
Monday8:00am6:00pm
Tuesday8:00am6:00pm
Wednesday8:00am6:00pm
Thursday8:00am6:00pm
Friday8:00am6:00pm
SaturdayClosedClosed
SundayClosedClosed
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

Testimonial

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!

- Sarah P.
East Wenatchee, WA

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