New Patient Paperwork

Snohomish Chiropractic & Nutrition 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.

  • Health History and Information Form

    This questionnaire will give your provider information about your overall health history. - Click to Download

  • Back Index

    This questionnaire will give your provider information about how your back condition affects your everyday life. - Click to Download

  • Neck Index

    This questionnaire will give your provider information about how your neck condition affects your everyday life. - Click to Download

  • The Patient-Specific Functional Scale

    This useful questionnaire can be used to quantify activity limitations and measure functional outcomes for patients with any orthopedic condition. - Click to Download

  • HIPPA Notice of Privacy Practices

    This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. - Click to Download

  • Acknowledgement of Notice of Privacy Practices (HIPPA)

    Click to Download

  • United Healthcare

    Only patients insured by United Healthcare need this form. Please complete the bottom “patient” section only. - Click to Download

OFFICE HOURS

Monday
9:00am - 12:00pm
2:30pm - 6:00pm

Tuesday
2:30pm - 6:00pm

Wednesday
9:00am - 12:00pm
2:30pm - 6:00pm

Thursday
Closed

Friday
9:00am - 12:00pm
2:30pm - 6:00pm

Saturday & Sunday
Closed

Snohomish Chiropractic & Nutrition

1405 Avenue D
Snohomish, WA 98290

(360) 863-3949