Welcome to Kraftick Chiropractic!

 

To make the wait in our office shorter for your first visit, you can download the initial paper work by clicking the button above.

Instructions for paper work:

• Page 1: Fill out each box and make sure you mark the picture of the body to illustrate where your pain or sensation is located.

• Page 2: Continue to fill out your case history on this page

• Page 3: Finish your case history on this page

• Page 4: Fill out the disclaimer givings us permission to treat you

• Page 5: Mark where your pain or sensation is on the picture of the body

• Page 6: Circle the letter the applies to the function of your neck and upper back.  If you have no pain, circle all As.

• Page 7: Circle the letter that applies to the function of your lower back.  If you have no pain, circle all As.

• Page 8: Circle the number that applies to the function your legs and arms (elbows, wrist, knees, or feet).  0 is completely functional and 10 is the inability to function.

• Page 9: Read the HIPAA policy and write down anyone you wish to see your exam or x-rays.  Sign and date stating you have seen this.

• Page 10: Sign and date this disclaimer stating you will allow us to speak to your insurance on your behalf and that you understand payment is due at time of service.

Note: Anyone under age 18 will need a parent and/or guardian to accompany him or her and has to be willing to sign a consent for the treatment of a minor.