Prepare for Your Visit: Complete Your Forms Online
Howard Chiropractic Clinic provides our patient forms digitally, allowing you to complete them at your own convenience. If you are a new patient with insurance through United Healthcare, Robin, Quartz, Preferred One, or Medicare, please select the appropriate new patient paperwork form for your insurance carrier and click on the provided links. These forms will supply our doctors with essential information regarding your medical history and the purpose for your visit.
Step 1: Fill out the New Patient Intake & HIPAA Consent Form
https://www.howardchiropractic.info/new-patient-form-hipaa-consent/
Step 2: Complete for each part of the body experiencing symptoms
Neck Pain Questionnaire:
https://www.howardchiropractic.info/neck-disability-index-form/
Back Pain Questionnaire:
https://www.howardchiropractic.info/back-disability-form/
Upper Extremity Questionnaire:
https://www.howardchiropractic.info/upper-extremity-form/
Lower Extremity Questionnaire:
https://www.howardchiropractic.info/lower-extremity-form/
Headache Pain Questionnaire:
https://www.howardchiropractic.info/headache-disability-index/
Please complete the Pediatric New Patient Paperwork
https://www.howardchiropractic.info/pediatric-medical-history-form/
Step 1: Fill out the New Patient Intake, ACN Document, & HIPAA Consent Form
https://www.howardchiropractic.info/united-health-new-patient-forms/
Step 2: Complete for each part of the body experiencing symptoms
Neck Pain Questionnaire:
https://www.howardchiropractic.info/neck-disability-index-form/
Back Pain Questionnaire:
https://www.howardchiropractic.info/back-disability-form/
Upper Extremity Questionnaire:
https://www.howardchiropractic.info/upper-extremity-form/
Lower Extremity Questionnaire:
https://www.howardchiropractic.info/lower-extremity-form/
Headache Pain Questionnaire:
https://www.howardchiropractic.info/headache-disability-index/
Step 1: Fill out the New Patient Intake, Global Health & Wellness Questionnaire, & HIPAA Consent Form
https://www.howardchiropractic.info/robin-quartz-preferred-one-insurance/
Step 2: Complete for each part of the body experiencing symptoms
Neck Pain Questionnaire:
https://www.howardchiropractic.info/neck-disability-index-form/
Back Pain Questionnaire:
https://www.howardchiropractic.info/back-disability-form/
Step 1: Fill out the New Patient Intake, Medicare Consent & HIPAA Consent Form
https://www.howardchiropractic.info/new-patient-intake-medicare-consent-hipaa-consent-forms/
Step 2: Complete for each part of the body experiencing symptoms
Neck Pain Questionnaire:
https://www.howardchiropractic.info/neck-disability-index-form/
Back Pain Questionnaire:
https://www.howardchiropractic.info/back-disability-form/
Upper Extremity Questionnaire:
https://www.howardchiropractic.info/upper-extremity-form/
Lower Extremity Questionnaire:
https://www.howardchiropractic.info/lower-extremity-form/
Headache Pain Questionnaire:
https://www.howardchiropractic.info/headache-disability-index/
Paso 1: Llenar y presentar el Formulario de Admisión para Pacientes Nuevos junto con el Formulario de Consentimiento de HIPAA
https://www.howardchiropractic.info/formulario-de-admision/
Paso 2: Completar para cada parte del cuerpo que presente síntomas
Cuestionario sobre dolor de cuello:
https://www.howardchiropractic.info/indice-de-discapacidad-del-cuello/
Cuestionario sobre dolor de espalda:
https://www.howardchiropractic.info/cuestionario-sobre-discapacidad-lumbar/
Step 1: Fill out the New Patient Intake & HIPAA Consent Form
https://www.howardchiropractic.info/auto-or-personal-injury-hipaa-forms/
Step 2: Complete for each part of the body experiencing symptoms
Neck Pain Questionnaire:
https://www.howardchiropractic.info/neck-disability-index-form/
Back Pain Questionnaire:
https://www.howardchiropractic.info/back-disability-form/
Upper Extremity Questionnaire:
https://www.howardchiropractic.info/upper-extremity-form/
Lower Extremity Questionnaire:
https://www.howardchiropractic.info/lower-extremity-form/
Headache Pain Questionnaire:
https://www.howardchiropractic.info/headache-disability-index/
Step 1: Fill out the New Patient Intake & HIPAA Consent Form
https://www.howardchiropractic.info/workers-compensation-hipaa-forms/
Step 2: Complete for each part of the body experiencing symptoms
Neck Pain Questionnaire:
https://www.howardchiropractic.info/neck-disability-index-form/
Back Pain Questionnaire:
https://www.howardchiropractic.info/back-disability-form/
Upper Extremity Questionnaire:
https://www.howardchiropractic.info/upper-extremity-form/
Lower Extremity Questionnaire:
https://www.howardchiropractic.info/lower-extremity-form/
Headache Pain Questionnaire:
https://www.howardchiropractic.info/headache-disability-index/
Step 1: Fill out the Subjective Progress Report
https://www.howardchiropractic.info/re-evaluation-form/
Step 2: Complete for each part of the body experiencing symptoms
Neck Pain Questionnaire:
https://www.howardchiropractic.info/neck-disability-index-form/
Back Pain Questionnaire:
https://www.howardchiropractic.info/back-disability-form/
Upper Extremity Questionnaire:
https://www.howardchiropractic.info/upper-extremity-form/
Lower Extremity Questionnaire:
https://www.howardchiropractic.info/lower-extremity-form/
Headache Pain Questionnaire:
https://www.howardchiropractic.info/headache-disability-index/
Step 1: Fill out the Re-Exam Packet
https://www.howardchiropractic.info/re-exam-form/
Step 2: Complete for each part of the body experiencing symptoms
Neck Pain Questionnaire:
https://www.howardchiropractic.info/neck-disability-index-form/
Back Pain Questionnaire:
https://www.howardchiropractic.info/back-disability-form/
Upper Extremity Questionnaire:
https://www.howardchiropractic.info/upper-extremity-form/
Lower Extremity Questionnaire:
https://www.howardchiropractic.info/lower-extremity-form/
Headache Pain Questionnaire:
https://www.howardchiropractic.info/headache-disability-index/
