Chiropractor New Patient Registration Intake

Try this mobile new patient intake form template to gather details about your chiropractic patients.

Offer quality health care services by gathering the important information and medical history of new chiropractic patients. This free new patient form template easily works on any mobile device as you can input patient information quickly to create accurate medical files when offering health care services.

Try our chiropractor new patient intake form for free on any mobile device with a free trial of IntouchCheck mobile form software. Sign up for a free trial today and ask your Intouch specialist to load this pre-built form into your account.

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The influx of new patients in the chiropractic office can get overwhelming on some days. People want fast, professional health care. Yet rushing through the intake forms can lead to medical mistakes and errors that can put a patient's life at risk. We have created the chiropractor new patient intake form for administrative purposes as your medical staff can easily input necessary patient information you need. This new patient form template provides all the required fields to expertly gather a patient's medical details right on your mobile device.

Form Details

The patient information form template can be used by a chiropractic office to gather medical information from new patients to create basic medical records. You can input patient contact information and medical history during the patient's first visit in the office. The form template can be used on mobile devices such as smartphones, iPhones, iPads and tablets. Get the accurate details about the new patient and then transfer the information into medical records quickly to cut down on the patient's wait time at the office.
The chiropractor new patient intake form includes the following field categories pre-created in the template:

  • Name
  • Email address
  • Preferred communication
  • Birthday/Gender/Language
  • Smoking status
  • Race
  • Ethnicity
  • Medication List
  • Medication Allergy List
  • Elect or not elect to receive clinical summary after each visit
  • Signatures
  • Dates

Customize the Chiropractic New Patient Intake Form

We know that every business is unique, and your forms should reflect that. Our ready-to-use template is a comprehensive list of industry standard fields, but it is most useful when customized to reflect your own needs. The IntouchCheck platform makes it simple to quickly customize the mobile form template to meet the individual needs of your company and goals; questions, fields, or sections can be quickly removed, and new queries or fields can be added in the appropriate places to fit your project.

Create Your Own Forms for your Chiropractic Practice

Already have processes and procedures in place? IntouchCheck’s straightforward interface makes it fast and easy to create your own forms, where you can customize the sections, categories, questions, and types of data/image capture fields. We’re here to help you get started! Try IntouchCheck for free, and see how easy it is to streamline your business processes.