Online Forms

Applied Healthcare Associates 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) or bring it with you to your appointment.

ADULT New Chiropractic Patient Intake Form (age 11+)- **Required if Applicable**

This let’s us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

WORKERS COMP. New Patient Intake Form - **Required if Applicable**

This let’s us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

MOTOR VEHICLE New Patient Intake Form - **Required if Applicable**

This let’s us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

CHILD New Chiropractic Patient Intake Form (age 10 and under)- **Required if Applicable**

This let’s us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

CONSENT TO TREAT A MINOR Form (ages 10 -18) -**Required for Children's Intake forms**

This let’s us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

MASSAGE Intake Form - **Required if Applicable**

This let’s us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

PRACTICE MEMBER GUIDELINES Form -**Required for ALL NEW PATIENTS!**

This let’s us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

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!