Online Patient Forms
Innovative Health offers our patient forms online so that you can save time at your visit by completing them before you even arrive at our chiropractic office.
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Download form(s), print, fill in, and bring them along to your appointment.
1) Chiropractic New Patient Health History – Required
This outlines the history and current state of your health. We also encourage you to write down any questions that you have, so that we can be sure to cover them during your appointment. Choose the appropriate form based on the patient’s age.
We also highly recommend that all New Patients download and complete this Insurance Benefits Worksheet.
Adults and Children over 6 years of age
Children ages 6 and under
2) Patient Reactivation – Required
If you are a returning patient, but haven’t been to our office within the past 3 months, we will need to collect more recent health information. Please choose the appropriate form based on how long it’s been since your last visit (if you’re unsure, please don’t hesitate to call us at 715-355-4224).
Your last visit was between 3 months and 1 year ago
Your last visit was more than a year ago
3) Insurance Benefits Worksheet – Recommended
This worksheet helps you to understand your insurance coverage by outlining the questions you should ask your insurance provider. It is important to know that it is your responsibility to verify your coverage and understand your financial share of the services we provide. We strongly recommend that you bring this completed form with you to your first appointment.
4) Medical Records Request
To transfer medical records between our office and another provider.
5) Workers’ Compensation
If your visit to our office was because of an injury that happened at work, please use this form. It is required for all Workers’ Compensation claims.
6) Auto Accident History
If your visit is due to an injury sustained in an auto accident, please use this form. It is required for all auto accident claims.
7) Personal Injury Supplement
Our staff will let you know if this form is required as a supplement to Form #1 (Patient Health History).
Download & Print Form
8) Functional Medicine & Nutrition Forms
NEW PATIENTS: completed forms are required PRIOR to scheduling your initial consultation. You will find the forms HERE.
STRESS ASSESSMENT: Only complete this form if you are told by the doctor to do so. Stress Assessment (Download & Print)
Are you ready to feel better?