New Patient Forms

On the Go Chiro offers our patient form(s) online so you can complete 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.

• New Patient Health History Form - Required

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

Download and Print Form

• Informed Consent Form - Required

This form enables  the doctor to exam and  treat  your conditions.

Download and Print Form

• Consent to Treat a Minor - Required

If the patient is a minor you must print this form and have the parent or guardian sign the form.

Download and Print Form

• Preservation of Patient Records Form - Required
  

This form tells you how OTGC will preserve your records.

Download and Print Forms

• Copy of  insurance card (front and back) - Required
  

• Financial Hardship Forms - Optional 

This form is for the patient who is going through Financial Hardship and qualifies for this offer of deferred payments.

Download and Print Form

• Member Wellness Registration - 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