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Krantz Family Chiropractic & Wellness Center offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), and fill in the required information before printing.
  • Bring in your printed and completed form(s) with you to your appointment to save time.

New Patient Forms

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

New Patient Health History Form

Chiropractic Patient Policies

HIPAA Short Forms

Insurance Notice Non Payable Form


Required Insurance Forms for New Patients:

ABN Form - Medicare Non-Covered Services

Medicare Notice Non-Payable Form


Complete the Form(s) Related to Your Condition

Neck Index Form

Back Index Form

Functional Index Rating

Disabilities of the Arm, Shoulder, and Hand Form 

Lower Extremity Functional Scale

Auto/Work Injury Form


Miscellaneous Forms

Credit Card Preauthorization

HIPAA Full Notice of Privacy Practices



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