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Online Forms

We offer our paperwork online so you can complete it in the convenience of your own home.

Admitting Forms

Please print out and complete these forms prior to coming to our office for your first visit.

pdf iconDownload & Print Form – New Patient Intake Form

pdf iconDownload & Print Form – Authorization Form

Adjusting Forms

These forms will help to prepare you for your first chiropractic adjustment. They do not need to be completed prior to your first visit at our office.

pdf iconDownload & Print Form – Informed Consent For Care Form

pdf iconDownload & Print Form – What To Expect Form

pdf iconDownload & Print Form – HIPAA Privacy Form

Current Patients Only

For those patients who have been treating at our office, please feel free to complete our Patient Satisfaction Survey. You can either complete it online and email it to us or print it out and return it anonymously by mail.

pdf iconDownload & Print Form – Patient Survey

If you are currently a patient at our office and have been involved in an automobile or worker’s compensation injury, please use this form.

pdf icon Download & Print Form – Auto And Work Comp Form

Records Transfer Forms

If you have received chiropractic care elsewhere, or have medical records we will need from another practitioner, please use this release form.

pdf iconDownload & Print Form – Records Request

If you have chiropractic or medical records at this office you would like sent to another provider, please use this release form.

pdf iconDownload & Print Form – Records Release

Free AdobeReader®

Get adobe readerEach form is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

Questions? Concerns? Give Goffstown Chiropractic Care, PLLC a call now and put your mind at ease.