New Patient Paperwork
Escobar Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- All forms are PDF files. You will need AdobeReader® to view them.
- If you do not already have AdobeReader® installed on your computer,
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.
New Patient Intake Form
Click to Download
Patient Information
Click to Download
Notice of Privacy Practices
Click to Download
Acknowledgement of Receipt of Notice of Privacy Policy
Click to Download
Informed Consent for Chiropractic Treatment
Click to Download
Standard Disclosure and Acknowledgement Form
Click to Download
Records Release Authorization
Click to Download
Notice of Initiation of Treatment
Click to Download
Authorization and Assignment of Benefits & ADDL- PIP
Click to Download