PATIENT FORMS

Read on to get yo' paperwork!

FILL THESE OUT FOR YOUR FIRST APPOINTMENT EVER
Preparation for your appointment

Print off these 4 forms, fill them out and bring to your first appointment. Yes, All of them!

Intake Form

Patient Financial Form 

Consent to Treat Form

Consent to Use PHI Form

ALSO...Please read this privacy policy! (This doesn't need to be printed but reference it here anytime!)

You should have 4 forms printed and filled when you get to the office.

FILL THESE OUT IF DR. AMY TELLS YOU TO
These are "OUTCOME ASSESSMENT TOOLS"

Print off these forms, fill them out and bring to your appointment only if Dr. Amy tells you to!

Upper extremity Functional Index Form

Lower extremity functional Index Form

Low Back - Oswestry Form

Neck Pain Form

Move Chiropractic

Address:
4500 36th Ave S STE 100
Fargo, ND 58104

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