Online Forms

McLaughlin Chiropractic Center offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print it out and fill in the required information.
• Fax us your printed and completed form(s) or bring it with you to your appointment.

SECTION I

Required for All Patients

Application For Treatment

Case History

Authorization, Records Release, and Assignment of Benefits   

Authorization for Appointment Reminders and Healthcare   

Functional Rating Index

Quadruple Visual Analogue Scale

 

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SECTION II

For Personal Injury Patients

 Auto Accident Form 

 

Assignment of Benefits     

                                                                                      

Functional Rating Index

 

Quadruple Visual Analogue Scale                                                                                                  

                                                         

 

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SECTION III

For Reactivation

For Patients who have not been treated in our office in the past 6 months and wish to re-activate their file, please complete the following:

Patient Reactivation Form  

                                                                                                                      

Functional Rating Index       

                                                                                                              

Quadruple Visual Analogue Scale

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Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. We also have a default user name and password located on the Home page of our website if you do not wish to register.  You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online or you can use our default user name and password. The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form

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