Chiropractic Forms | Cummins Chiropractic & Wellness
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New Patient Chiropractic Intake Form

Welcome!  Please use this New Patient Form link to complete your new patient chiropractic paperwork AFTER scheduling your appointment.
Still need to schedule your new patient appointment?  Use the link below.

New Patient Form Schedule Appointment

Existing Patients Forms

Patient Intake: Chiropractic

Patient Intake: Massage

Disability of the Arm, Hand & Shoulder (DASH)

Functional Rating Index

Headache Disability Index

The Lower Extremity Functional Scale

New Complaint Form

Quadruple Visual Analogue Scale

TMD Disability Index

Pediatric Outcomes Form

Progress Evaluation Form

PSF Form

Records Request Form

Records Release Form

Spanish Patient Form

Providing Chiropractic Care for you and your family.

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A panoramic view of a chiropractic clinic with multiple black treatment tables for Postural Distortion Treatment, exercise equipment, wooden floors, large windows, green and beige walls, and various medical devices and supplies neatly organized.