Online Forms

Alpine Wellness Chiropractic offers our patient form(s) online so they can be completed 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.
  • Please bring your completed forms with you to your appointment. 

ADULTS

Adult New Patient Health History Form - Required

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!

Download & Print Form

Adult Reactivation Form - (if you have not been seen in more than 1 year but less than 3 years)

This let’s us know the history and current state of your health and gives us an update of your status since we saw you last. Also updates treatment consents and administrative records.

Download & Print Form

CHILDREN

Child New Patient Health History Form - Required

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

Download & Print Form

All Children Under Age 5

Developmental Milestones Download & Print Form

All Children Under Age 7

Birth Records Release Download & Print Form

PREGNANT MOMS

Prenatal New Patient Health History Form - Required

This let’s us know about your pregnancy so far and the state of your health beforehand. What questions, concerns, goals, regarding your pregnancy can we help you with? Let us know!

Download & Print Form

INSURANCE PAPERWORK

If you have one of the following insurances, additional paperwork is REQUIRED:

 United HealthCare
  Cypress Care
  Medical Resource, LLC
 Great-West HealthCare
  Evercare
  Premera Blue Cross
 PacifiCare Health Systems
  GE Wellness Plan
  Principal Life Insurance Co.
 Secure Horizons
  Golden Rule, Inc.
  Reserve National
 Align Networks, Inc.
  Health Allies
  Universal SmartComp

REQUIRED ADDITIONAL FORMS:

ALL 3 FORMS ARE REQUIRED

Patient Summary Form: Download & Print Form

Neck Index: Download & Print Form

Back Index: Download & Print Form

WEIGHT LOSS

Please go to the WEIGHT LOSS tab to find the appropriate forms

Motor Vehicle Accident Forms

(In Addition To Above Paperwork) - Select Appropriate Age Group

Child MVA History
Download & Print Form

Adult MVA History
Download & Print Form