Patient Forms

Heartland Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office. Completing them prior to arriving at the clinic for your first appointment will save you significant time on your visit.

Instructions: click on the necessary form, fill it out, and submit it online.

New Patient Intake Form – Required

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! The history and consent forms must be filled out BEFORE any assessment or treatment can be given.

New Patient Intake/Re-scan Form

COVID-19 Screening Form

Please fill out this form prior to your appointment and let us know you have completed it when you arrive.

COVID-19 Screening Form

Consent to Disclose Personal Information Form

Personal Information Consent Form

X-Ray Consent Form

X-Ray Consent form