New Patient Paperwork
Snohomish Chiropractic & Nutrition offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- All forms are PDF files. You will need AdobeReader® to view them.
- If you do not already have AdobeReader® installed on your computer,
Click Here to download. - Download the necessary form(s), print them out and fill in the required information.
- Bring the necessary form(s) to your appointment.
Health History and Information Form
This questionnaire will give your provider information about your overall health history. - Click to Download
Back Index
This questionnaire will give your provider information about how your back condition affects your everyday life. - Click to Download
Neck Index
This questionnaire will give your provider information about how your neck condition affects your everyday life. - Click to Download
The Patient-Specific Functional Scale
This useful questionnaire can be used to quantify activity limitations and measure functional outcomes for patients with any orthopedic condition. - Click to Download
HIPPA Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. - Click to Download
Acknowledgement of Notice of Privacy Practices (HIPPA)
Click to Download
United Healthcare
Only patients insured by United Healthcare need this form. Please complete the bottom “patient” section only. - Click to Download
Monday
9:00am - 12:00pm
2:30pm - 6:00pm
Tuesday
2:30pm - 6:00pm
Wednesday
9:00am - 12:00pm
2:30pm - 6:00pm
Thursday
Closed
Friday
9:00am - 12:00pm
2:30pm - 6:00pm
Saturday & Sunday
Closed
Snohomish Chiropractic & Nutrition
1405 Avenue D
Snohomish, WA 98290