Online Forms

Erickson Clinic of 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.

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Documentation is very important - especially in the case of insurance filing. Please take a moment and fill out the following forms thoroughly.

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New Patient Form

Download & Print Form  (This form is required for treatment if you are a new patient.)

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Health Questionnaire

Download & Print Form  (This form is required for treatment if you are a new patient.)

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Notice of Privacy Practices (HIPPA)

Download & Print Form (This form is required for treatment if you are a new patient.)

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Informed Consent to Treatment

Download & Print Form (This form is required for treatment if you are a new patient.)

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Non-Covered Services

Download & Print Form (This form is required for treatment if you are a new patient.) 

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Personal Injury/Auto Accident Patient Forms  (These forms are required in addition to the above forms if you were involved in an automobile accident or have a worker's compensation injury.)

Download & Print Forms 

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Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form

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