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Request an Appointment

Crosswinds Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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) or bring it with you to your appointment.

New Patient Intake Form - Required

As your doctors office we would like to get to know you! Please fill out our intake sheet so that we can start the bonding experience.

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New Patient Symptom Questionnaire - Required

Getting to know out patients is very important to us. This form will help with communication between you and your doctor so, that he can see right off how he can start helping you. 

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New Patient Health History Form - Required

This lets us know the history of your health. This is another great tool for you and your doctor to use to help better assist you on your road of healing.

Download & Print Form 


Consent to Treat - Required

This allows the Doctor to treat you as well as informing you to the risks associated with Chiropractic care.

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H.I.P.P.A Form - Required

​This informs you of your rights to privacy and our legal duty to you as a medical provider.

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Automobile Accident Fact Sheet - *Necessary only if you have been involved in a motor vehicle accident*

​We want to make sure you are taken care of. When you are in a motor vehicle accident, it is important that we know all the details of your accident so we can treat you properly. Please fill out the form to the best of your knowledge, for the Doctor's review.

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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 chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, 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!

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