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 them 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 or work injury?

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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SINCE 1951



(608) 846-3333 • 312 East North Street


Sun Prairie  

(608) 837-7600 • 725 West Main Street


(608) 849-9014 •  612 East Main Street



(608) 592-1400 • 801 N Main Street, Suite B