Patient Forms

To help make your first visit easier, Chattanooga Upper Cervical Chiropractic may provide patient forms that can be completed before your appointment.

If online forms are available, please complete them before your visit so our team can review your information and better understand your health history, concerns, and goals for care.

Patient Forms

New Patient Forms

Available forms may include:

  • New patient intake form
  • Health history form
  • Consent to care
  • Privacy acknowledgment
  • Pediatric intake form, if applicable
  • Pregnancy intake form, if applicable
  • Insurance or payment information, if applicable

Only forms approved by the practice should be linked on this page.

Before You Submit Forms

Please make sure you are using the secure form or approved submission method provided by the office.

Do not submit sensitive medical information, insurance details, or protected health information through a general website contact form unless the form is secure and intended for that purpose.

If you are unsure, please call the office before submitting your information.

What to Bring to Your First Visit

Please bring:
  • Photo ID
  • Insurance information, if applicable
  • Completed forms, if not submitted online
  • List of current medications
  • Prior imaging reports, if available
  • Relevant health history
  • Questions you would like to ask

If Online Forms Are Not Available

If patient forms are not currently available online, please contact the office before your appointment.

Our team can let you know whether paperwork will be completed in person, sent through a secure method, or provided another way before your visit.

Privacy and Security Reminder

Patient forms may request private health information. Please only submit forms through a secure and approved method.

Do not use general website forms for emergencies, urgent medical concerns, detailed health history, or private medical information unless specifically directed to use a secure form.

NEW PATIENTS

Contact the Office

Questions about patient forms?
Chattanooga Upper Cervical Chiropractic
Contact Us at Chattanooga Upper Cervical Chiropractic

Important Healthcare Disclaimer

The information on this page is provided for general educational purposes only. It is not medical advice, diagnosis, treatment, or a guarantee of results.
If you are experiencing a medical emergency, call 911 immediately.