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We offer our patient forms online so you can complete them at your convenience.  The forms usually take about 15 - 20 minutes to complete.

Download the PDF if you want to print the forms, complete them, and bring them with you to your appointment.

Download the Word version if you want to complete them and email them back to russ.family.chiropractic@gmail.com

If this is all too confusing, just come in 15 - 20 minutes before your appointment and you can complete the forms in our waiting room.

New Patient Registration

We need to know who you are!  If you are planning to use insurance, fill in the insurance portion of this form.

Download patient registration form (PDF)

Health history, description of services, fees, and consent to treatment.

This form asks about your current and past health and what problems you would like to address.  It will give you the chance to read about our approach to chiropractic.  The fees and financial responsibilities are described in detail.  We ask that you read information about the treatments we use, and about our privacy policy.  Several signatures are required on this form.

Download the health history, services, and fees form (PDF)

Download the form in MS Word Format

Insurance coverage verification.

This form provides you with the questions you must ask your insurance company to find out if Dr. Russ's treatments will be covered by your insurance. 

Download the insurance verification form (PDF)

Informed Consent for Child: required for patients under the age of 18.

This form describes our approach to treating children and teens.  Parents must read and sign this form before any patient under the age of 18 can be examined or treated.

Download the consent to treat a minor form (PDF)

Download the form in MS Word Format