Back to Balance Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
If you have any questions or concerns about the information presented in the paperwork, do not hesitate to give us a call at (559) 783-2225.
New Patient Form - Required
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-forms.doc functional-rating-index-1-page.pdf
Pediatric Form - Required
This form is for children aged 0 to 5 years.
pediatric-forms-0-5-yrs.doc functional-rating-index-1-page.pdf minor-consent-form.doc
Children's Form - Required
These forms are for children aged 6 to 11 years.
children-6-11.doc functional-rating-index-1-page.pdf
Reactivation Form - Required
These forms are for established patients, that have not been under care in over 90 days.
reactivation-form-1.doc functional-rating-index-1-page.pdf minor-consent-form.doc
AHS Form-
ash-patient-progress.pdf functional-rating-index-1-page.pdf