Menu

Call today:

Online Forms

New Patient Online Forms

Johnson Chiropractic & Holistic Health Center offers our new patient form(s) online so they can be completed in the convenience of your own home or office.

We have three areas from which to choose forms. Please choose the appropriate forms from one of the three sections below.

Click the links below to download, print, and fill them out. Don't forget to bring them with you to your first appointment!


Chiropractic & Acupuncture New Patient Forms

If you were in an automobile accident, please continue down to the Auto Accident section and print the forms found there.

1. Chiropractic & Acupuncture Intake

2. Back Pain Questionnaire - Required if you have BACK PAIN

3. Neck Pain Questionnaire - Required if you have NECK PAIN

4. Headache Questionnaire - Required if you have HEADACHES

If you have Medicare, the following form is required:

Medicare Advance Beneficiary Notice of Non-Coverage (ABN)

If you wish to have your records released for any reason you are required to fill out the form below. This includes release to family, other medical facilities, legal representative, etc.

Records from Johnson Chiropractic to Another Party

Records from another party to Johnson Chiropractic


Functional Medicine Forms

1. Functional Medicine Intake Form - these forms will be provided in office.


Auto Accident Patients

These forms are required if you are seeking treatment due to an automobile accident

The following forms are required for auto injury cases.

1. Auto Injury Intake Form

2. Back Pain Questionnaire - Required if you have BACK PAIN

3. Neck Pain Questionnaire - Required if you have NECK PAIN

4. Headache Questionnaire - Required if you have HEADACHES

5. Health Records Release Form


Download the Free AdobeReaderĀ®

Location

Find us on the map

Clinic Hours

Dr Johnson's Patient Care Schedule

Columbia Office

Monday:

9:00 am-12:30 pm

2:30 pm-6:00 pm

Tuesday:

9:00 am-2:00 pm

Wednesday:

9:00 am-12:30 pm

2:30 pm-6:00 pm

Thursday:

11:00 am-6:00 pm

Friday:

9:00 am-2:00 pm

Saturday:

Closed

Sunday:

Closed

Testimonial