Online Forms

Bakke Chiropractic Clinic offers many of our patient forms online so you can complete them in the privacy and convenience of your home.

Download the necessary form(s), print it out, and fill in the required information. Bring the completed forms with you to your appointment.

 

The following forms are available at this site:

  • New Patient Forms (Confidential Information, Health History, Pain Diagram)
  • Work Injury
  • Car Accident
  • Personal Injury (not car related)
  • Children's Health History Forms
  • HIPAA Information (Patient Privacy Policies)
  • Authorization to Disclose Information

 

Important: Please be sure to bring in your latest insurance information with you at the time of your appointment

 

 

 New Patient Forms

**Health History Form, Confidential Patient Information and Pain Diagram - Required (3 different forms)

It's important to have our doctors know your health history as well as what brings you to our clinic. We also need basic information about you for our files and we want to know "where it hurts".

Download & Print Forms

 

 Injury at Work Forms

Did you have a work injury? We need to know where it happened, how it happened and important work contact information. 

Download & Print Forms

 

Moving Vehicle Injury Information

Were you injured in a car accident? We need all the details and information about your injuries so we can provide the most effective care.

Download & Print Forms

 

 Personal Injury History and Information

 Did you have a fall or some injury not related to a car accident?

Download & Print Forms

 

Health History Forms for Children

Newborn, Infant (7 mos to 3 yrs), Pre-school and School age.
Required basic information for our records and files and so we can  identify your child's needs, conditions and best treatment approaches.

Download & Print Forms

 

HIPAA Notice - Privacy information and clinic policies

Read - Notice of Privacy Practices

 

Download and print receipt of privacy form

 

Authorization to Disclose Information

Download & Print Form

 

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