New Patient Paperwork

If you’re a new patient with Proactive Chiropractic, welcome! We’re proud to be part of your journey toward pain relief through chiropractic care.

To help serve you better and to make your first visit with us as productive as possible, we’ve compiled a list of four forms you’ll need to fill out prior to your appointment. Download them using the links below, fill them out and bring them with you.

All forms are PDF files. You will need AdobeReader® to view them.
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Click Here to download.
Download the necessary form(s), print them out and fill in the required information.
Bring the necessary form(s) to your appointment.

Download Forms

This form helps us obtain your demographic information quickly. It also helps us gather information about your pain and past medical history so we can create a treatment plan that…
Download Case and Family History

This form gives us permission to treat you and solidifies our promise to discuss any risks involved with your treatment.
Download Medical Consent Form

This form outlines how your health information will be used in our office and serves as your consent for its use.
Download HIPAA Form

This form gives Dr. Khlebopros permission to perform x-rays during your visit.
Download X-Ray Consent Form

Forms

This form helps us obtain your demographic information quickly. It also helps us gather information about your pain and past medical history so we can create a treatment plan that works best for you.

This form gives us permission to treat you and solidifies our promise to discuss any risks involved with your treatment.

This form gives us permission to treat you and solidifies our promise to discuss any risks involved with your treatment.

This form gives Dr. Khlebopros permission to perform x-rays during your visit.

FIRST VISIT CHECKLIST

Come Prepared, Leave Confident

Bring these items to ensure a smooth and efficient first appointment.

Completed Patient Forms

Download and fill out beforehand to save valuable time during check-in.

Valid Photo ID

Driver’s license or government-issued identification for verification.

Insurance Card

Current insurance card if you plan to use coverage for services.

Accident Documentation

Police reports, workers’ comp claims, or injury-related paperwork.

Referral Information

Details from your referring physician, attorney, or healthcare provider.

Medication List

Current medications, supplements, and dosages you’re taking.

What Our Patients Are Saying

“After my car accident, Dr. Thompson got me in the same day. His treatment plan was thorough and I’m now pain-free. Highly recommend!”

“The team at ProActive handled all my insurance paperwork and helped me recover from my work injury. Professional and caring!”

“I’ve been to many chiropractors, but Dr.Thompson’s approach with spinal decompression changed my life. No more back pain!”