Children Intake TOS and Insurance DocumentFamily Chiropractic at Northwest Wellness Center offers our patient form(s) online so they can be completed it in the convenience of your own home or office. We have separate forms for you based on if you plan to pay at time of service or use your insurance, if you have been in an automobile accident, or if you are on a workers compensation injury. Please download the appropriate form.
- 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.
Insurance or Time of Service for Adults
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!
Insurance or Time of Service for Children
Children Forms are for patients 13 years old and under. Thank you!
No Surprises Act Notice