Online Forms

Encompass Chiropractic Health 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.

General New Patient Health History 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!

Personal Injury New Patient Health History Form - Required

This lets us know you were involved in an accident as well as the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

Work Related Injury New Patient Health History Form - Required

This lets us know this is a worker's compensation case as well as the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

Questionnaires - Required

These are questionnaires that, for insurance purposes, help us objectively track your problem or complaint. Please choose the forms that apply to your situation and/or the forms instructed to complete by our staff.  Take your time and answer every question to the best of your ability.

Low Back Form

Upper Back and Neck Form

Headache  Form

Carpal Tunnel Form

Metabolic Assessment Form

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!